Do psychopaths need to be cured?

[Hans de Vries]

If a cure for psychopathy is available, should people be forcibly subjected to it?

 

Not all psychopaths are violent. A lot of high functioning psychopaths are business executives, politicians, surgeons as well as successful soldiers and policemen. All activities that require lack of empathy and calmness under pressure.

[iNow]

17 minutes ago, Hans de Vries said:

If a cure for psychopathy is available, should people be forcibly subjected to it?

No, because:

17 minutes ago, Hans de Vries said:

Not all psychopaths are violent

... and even if they were, it should still be subject to due process. 

[MigL]

There are two ways to look at it...

1 - It is a deviation from the normal, and, being unpredictable, could result in danger to themselves, or others.
2 - It is part of a 'spectrum', and until there is demonstrated danger to themselves, or others, they should be left to live as they see fit.

The first way, results in people trying to 'cure' homosexuality, as it is also a deviation from the norm.
The second results in mentally challenged, homeless people being left on the streets to freeze in -20^o temps, because they refuse to go to homeless shelters.

I don't know which of th two is more cruel, but I do know that this is not a simple question with a yes/no answer.

Edited January 21, 2021 by MigL

[CharonY]

There is also confusingly a range of uses associated with the term psychopathy but I do not think it is diagnostic order in the proper sense. Rather there are commonly used to refer to a set of traits that are associated with certain disorders.

At the same time MigL point about spectrum is relevant, as even the diagnosis of actual disorders are not trivial and rarely as black and white as some other medical diagnoses. 

[iNow]

I mostly object to the idea of forcibly doing anything to someone. I’m reminded of forced sterilization. 

[CharonY]

14 minutes ago, iNow said:

I mostly object to the idea of forcibly doing anything to someone. I’m reminded of forced sterilization. 

It goes toward the need for free and informed consent, which is a critical element in all medical procedures. However, there are of course many cases, even in recent times, when folks where compelled to certain unnecessary procedures, which goes against this principle.

And there are still grey zones when there are medically relevant procedures, but the patient is, for whatever reasons, unable to give free consent.

[MigL]

Society is often able to forcibly do all sorts of things to people through Government legislation; and I'm sure you agree with  lot of them.

They are able to confine you to a cell or house, if you are imprisoned or quarantined.
They are able to tie you up, whenever you drive your vehicle, with a seat/shoulder belt.
And many more.

We don't protest these laws because we realize it is for our own good.
Why are we so squeamish about forcing a mentally sick person off the street, and into a shelter, so he doesn't freeze to death, simply because his sick mind is telling him he doesn't want to go there ? Should we let him die in the cold ?

( this is not specifically about psychopaths anymore, but all mental conditions, or, the 'spectrum' in fashionable speak )

[iNow]

The error I see is with the underlying suggestion that there’s some binary state of mental processes: normal vs abnormal. This flawed foundation then jumps you into the next conclusion that the “typicals” should have the authority to involuntarily and forcibly change the “atypicals” without their consent.

Beyond the failure to realize that we all exist along a spectrum (not in a binary state)...there’s the added issue of how this looks rather like an entry-level eugenics program. Master race and purity connotations abound. 

Bound feet also come to mind, how young girls had their feet broken to make the small. Genital mutilation and clitoral slicing, forced sterilization, and now this suggestion with psychopathy... Just because the object here is the mind and not the body doesn’t mean the outcome being proposed is any better. 

Edited January 22, 2021 by iNow

[MigL]

Exactly why this is not a simple question, and needs both sides to be considered at length.
The 'typicals' should not have the right to force 'atypicals' into doing things they don't want, and I certainly understand your viewpoint, INow.
But what if the 'atypicals' cannot make an informed decision ( and who decides if they can, or not ), or if the decisions they make are detrimental to their well being, or even dangerous to their, or other's lives ?
Is it more compassionate to take away their rights, and force them to do things for their own safety, or more compassionate to let them be who they are, and do what they choose, and watch as they hurt themselves, or possibly die?

This is similar to the ongoing assisted suicide thread, "Is Suicide Right or Wrong ?", in Ethics.
You could make the argument that a person who's in great pain ( akin to being tortured continuously ), cannot make the informed decision to end their own life.
Should we let them ?

[iNow]

29 minutes ago, MigL said:

what if the 'atypicals' cannot make an informed decision ( and who decides if they can, or not ), or if the decisions they make are detrimental to their well being, or even dangerous to their, or other's lives ?

https://journalofethics.ama-assn.org/article/influence-psychiatric-symptoms-decisional-capacity-treatment-refusal/2017-05

Quote

Determinations of medical decision-making capacity are intended to uphold patients’ rights to make their own medical decisions but at the same time protect them from their decisions when their capacity is compromised. It should be noted that capacity is attached to a particular medical decision (e.g., consent to treatment, participation in research) at a particular time [1]. A person lacking capacity for one medical decision may have capacity for other decisions [2]. 
<...>
Competence is a legal determination of mental capacity that includes those abilities evaluated by clinicians in assessing decisional capacity. The legal standards for evaluating capacity are generally based on patients’ ability to: (1) understand the relevant information about their condition and proposed treatment; (2) appreciate the nature of their situation, including their underlying values and the potential consequences of their choice; (3) reason about the potential risks and benefits of their choices; and (4) express their choice [4, 5]. This assessment process is in accordance with the American Medical Association Code of Medical Ethics’ “Opinions on Consent, Communication & Decision Making” [6]

One imagines they’d have to be EXTREMELY handicapped not to have capacity for deciding whether or not to cut out various pieces of their brain (surgically or chemically) or their personality. 

35 minutes ago, MigL said:

You could make the argument that a person who's in great pain ( akin to being tortured continuously ), cannot make the informed decision to end their own life.
Should we let them ?

Yes

[MigL]

I don't know how cold it gets in Iowa during the winter INow, but in the Great Lakes region, I have seen it get to -25^o C at night, close to -40^o with the wind chill.
If you ever walk by a mentally ill homeless person, who will not go to the homeless shelter down the street, but would rather sleep on the sewer grate in those temperatures, because he's afraid they will steal the dolls he has in his bags,at the shelter, and you decide that it's a good idea to leave him to do as he wants, and you can feel good about your actions, you are a better man than I am.

True story, incidentally.
Never did convince him to go to the shelter, but took him to Tim Horton's and we had hot coffees for an hour or two.
Still feel bad about it to this day ( almost 20 years later )

[iNow]

1 hour ago, MigL said:

I don't know how cold it gets in Iowa during the winter INow, but in the Great Lakes region, I have seen it get to -25^o C at night, close to -40^o with the wind chill.

Sounds downright tropical 

1 hour ago, MigL said:

but would rather sleep on the sewer grate in those temperatures, because he's afraid they will steal the dolls he has in his bags,at the shelter

This individual likely lacks the capacity to offer informed consent for treatment, but treatment in this case is likely different than what it would take to “cure” psychopathy. Some sleep, a decent meal, a bit of therapy, possibly some well understood and extremely well tested meds... all reasonable rational approaches to treatment... not suggestions of “cure” which call to mind lobotomies. 

Edited January 22, 2021 by iNow

[MigL]

That seems to be a misconception of what you consider a 'cure' ( lobotomies ? really ? )

I know one really nice homeless guy, Frank M., who hangs around the area. He lost his way when his sister committed suicide, is paranoid, and hears voices.
His dad worked with mine, and he has a fantastic memory, recalling events from when we were both young in the 70s.
I have often given him money, and when his Government check comes in, he always insists on repaying it.
He could live at home with his mother and live a fairly 'normal' life ( he has at times ), but he chooses to live on the streets and not take his 'cure'.
His cure consists of medication, not a lobotomy.

Often times the 'cure' may only consist of counselling.

[iNow]

47 minutes ago, MigL said:

His cure consists of medication, not a lobotomy.

Often times the 'cure' may only consist of counselling.

Frank, based on what you've described here, is also not a psychopath. There are important differences between his experience and what the OP refers to.

Let me ask this another way. What would a treatment or cure for psychopathy entail in your opinion?

[Area54]

19 hours ago, Hans de Vries said:

If a cure for psychopathy is available, should people be forcibly subjected to it?

This presumes that psychopathy is an illness in need of a cure. Your note that there are many occupations in which a psycopath can thrive, to the benefit of society, is an implicit acknowledgement that such is the case. And yet your question also implies that the net consequence of psychopathic behaviour is negative for society. Ought we not, then, to focus on the behaviour, distinguishing positive from negative, and seeking ways to ehance the former and mitigate against the latter?

[CharonY]

And again, I think some of the discussion here is a bit problematic due to the different uses of "psychopathy". It is not quite clear what OP specifically meant. Hearing voices is not part of that, for example. Rather they are associated with a broad range of other psychiatric disorders but can also be caused by brain tumors. Not taking help is not a cure and could be caused by paranoid conditions, traumatic episodes and a whole range of other issues. 

Taking money or going to a shelter is not a cure, but would be consider normative behaviour, something that a person may willingly reject or is unable to conduct due to a disorder. 

Or to put it differently, someone suffering from the consequences of trauma cannot be cured per se and not certainly by forcing them to behave normally. Instead, they need help to manage their trauma and it is not something you can really force upon someone.

[MigL]

Exactly.
There is a wide range of mental conditions, some of which overlap, and the reason we call it a spectrum.
All of us belong on this spectrum, and therefore human behaviour, even with 'normals' or 'typicals' is a largely unpredictive science, compared to math, physics or chemistry.
There are also a wide range of 'cures', ranging from operable tumors, to medication, or even therapy.

A blanket 'no' to all cures, forced or not, seems shortsighted.
What is jail ( supposed to be ) other than rehabilitative therapy for wide-range psychopaths ?

Similarly a blanket 'yes' is also problematical, because in some cases of mental conditions, it makes things worse by re-enforcing the problem.

That has been my position from the beginning; this is not a simple question.
( actually, one could argue our current prison system does the same )

[CharonY]

I think it should be then expanded to cover all mental illnesses. The important bit relevant to OP is that for many, if not most there is no cure or rehabilitation. It is about managing it. Punishment does nothing to improve things like antisocial personality disorder. In fact, they tend to make things worse. There are behavioural therapies that can help folks to fit in, but it is more expensive and time consuming and therefore typically not available. And if you are rich enough some of this behaviours might even be beneficial (i.e. there is also a socioeconomic component to it).

So fundamentally I would say no to forcing a cure, as there is none. Treatment and support even if they do not want it, probably yes, if it can be done in a non-harmful way.

 

 

[John Cuthber]

I'm not sure it's meaningful to talk of "curing" psychopaths.
But could we please stop electing them to positions of power?

[MigL]

17 hours ago, CharonY said:

So fundamentally I would say no to forcing a cure, as there is none.

I would think that a 'cure' is any process which moves you closer to the center of the 'spectrum', or, what is considered normal.
Psychopathic thoughts are common to a wide range of people; we all have 'dark' thoughts from time to time.
( I have often thought of going to England to beat up Dimreepr, when he makes one word/obscure posts   )
The difference is that most people's psyche has built-in checks to control those 'dark' thoughts; people who get diagnosed as 'psychopaths' are missing those checks ( in various degrees ), and act on those 'dark' thoughts.

For mild cases of psychotic behavior the 'cure' is as simple as therapy which allows the person to recognize the harm they do by acting on those 'dark' thoughts. Imprisoned criminals are usually asked if they regret the harm they caused to others; an indication they have been rehabilitated, when they're up for early release/parole

Edited January 23, 2021 by MigL

[CharonY]

8 hours ago, MigL said:

I would think that a 'cure' is any process which moves you closer to the center of the 'spectrum', or, what is considered normal.

Well, the disorders stay. Management means that folks exhibit normative behavior (or emulate it). But it is not that the folks will suddenly feel empathy. They might learn that folks expect not to behave a certain way, but that is the best you can hope for. The issue with harm is that folks with certain antisocial disorders simply are unable to see that doing harm is a bad thing. It is like trying to cure blindness by telling folks to behave as if they were able to see. Both require ongoing management.

What makes it really difficult is that folks with this disorder are unable to see that something is wrong to begin with. While they can learn to pretend, it is often difficult as typically they do not feel to the need to fit social norms and do not understand soecietal expectations. I think the otherness of the disorder is really difficult to convey as you and me would frame it in a context that makes sense to us, but for people with this disorder it simply would be gibberish. Again, it is part of their personality and cannot be changed and it is quite a different beast than, say, mental illnesses.

 

[Hans de Vries]

Research is ongoing. In the future we may be able to reverse the deficits of empathy. White matter in certian regions could be strengthened or weakneed, gray matter volume modified, chemsitry of the brain could also be changed.

[dimreepr]

7 minutes ago, Hans de Vries said:

Research is ongoing. In the future we may be able to reverse the deficits of empathy. White matter in certian regions could be strengthened or weakneed, gray matter volume modified, chemsitry of the brain could also be changed.

Eugenics' by any other name, smells as bad.

[Hans de Vries]

More like brain hacking IMO.

 

The issue with psychopathy/ASPD is that even if the individual is not violent, he/she can still cause a ton of psychological harm to others. I would not envy someone to have a boss or a co-worker who is a psychopath. Mind that psychopaths make some 5% of CEOS even though their prevelence in general population is approx. 1%

 

There are already significant insights into the pathophysiology of ASPD like abnormal opioid system in the brain and abnormal glucose metablism which IIRC predicts psychopathy with better accuracy than psychological tests do.

Edited January 24, 2021 by Hans de Vries

[dimreepr]

24 minutes ago, Hans de Vries said:

More like brain hacking IMO.

Who guards the guardian?

28 minutes ago, Hans de Vries said:

The issue with psychopathy/ASPD is that even if the individual is not violent, he/she can still cause a ton of psychological harm to others.

As can anyone who is anonymous on social media...