Introduction
From its Greek etymology of ‘diseased mind’ (Skeem et al., 2011) to the list of twenty characteristics that oft-represent it (Hare, 2003), psychopathy’s history is convoluted — much to the disarray of Clinical and Research psychologists’ views.
A suitable method of identifying and diagnosing individuals had to prevail, leading to the inception of the Psychopathy Checklist-Revised (PCL-R) (Hare, 2003). The PCL-R would later morph into a “gold standard” (Vitacco et al., 2005) for psychopathic traits’ evaluation and psychopathic convicts’ recidivism.
However, numerous psychologists have criticised the PCL-R for its pseudo-spectral approach and questionable operationalisation (Venugopal, 2020). A breakdown of the aforementioned psychologists’ arguments and an investigation into the PCL-R’s efficacy in diagnosing psychopathy is what follows in this blog.
Background
A nuanced understanding of the PCL-R’s criticisms necessitates an understanding of its radices. Despite Robert Hare being the checklist’s author, its origins stem from Hervey Cleckley’s efforts to first operationalise psychopathy (Cleckley, 1988).
Cleckley’s The Mask of Sanity highlights the semi-structured interviews conducted with Georgia’s University Hospital’s psychiatric patients. This idiographic approach yielded a list of sixteen criteria which characterised psychopaths as — amongst other things — “not deeply vicious” and “shallow” (Cleckley, 1988). A notable fact is that Cleckley refrained from establishing psychopathy’s foundations on criminal behaviour; whether this was intentional remains unknown.
Perhaps a more remarkable finding, Cleckley reported numerous instances of psychopathy’s “incomplete diagnoses” (Cleckley, 1988). Later termed “functional psychopaths” (Theodorakis, 2013), such individuals’ traits were comparable to that of the psychiatric patients’ despite reportedly hailing from high-functioning backgrounds. Such cases were, however, sparsely investigated.
Evaluation
Despite the semi-structured interviews offering a balance between structured and exploratory forms of interrogative research (Venugopal, 2020), the lack of empirical data and the over-reliance of self-reported data renders Cleckley’s findings questionably valid; psychopaths’ reported skilfulness at manipulation exacerbates the same.
Considering that Cleckley’s criteria were based on a sample exclusively consisting of psychiatric patients, the generalisability of his findings are thrown into question. Said psychiatric patients could have conceivably held back their violent tendencies due to their institutional admission or medication — leading to antisocial behaviour being less emphasised in Cleckley’s descriptions.
However, it also seems necessary to include antisocial behaviour as an important criterion as the sample of psychiatric patients were plausibly institutionalised due to their antisocial behaviour. Whilst the violent history of the patients are unverifiable today, were it to be true, Cleckley’s findings’ credibility would also wane.
Nevertheless, these seminal — albeit flawed — findings are what led to the formation of an empirically-backed ‘checklist’ for psychopathy in the 1970s (Venugopal, 2020).
PCL-R
Creation
The PCL-R, as it stands today, consists of 20 criteria intended to represent a paragon psychopath, and is graded on a 0–2 scale (Hare, 2003). A score ≥ 25/40 is considered the minimum for legal classification — in the European Union — and for research (Skeem et al., 2011). The PCL-R is divided into two factors, each comprised of two sub-factors.
Through myriad correlational studies and meta-analyses, Hare’s nomothetic research methodologies yielded a ‘2-factor model’ whose validity was substantiated in his 2008 meta-analysis — condensed into Figure 1.
Figure 1
Correlation visualisation (Hare et al., 2008)
These correlations were also a result of idiographic approaches via observation studies. Nevertheless, employing correlational analysis to Hare’s list of twenty criteria led to the first quantitatively-driven effort to operationalise psychopathy. In addition to the correlations themselves having been substantiated by other parties (Blair et al., 2005; Patrick, 2006; Leistico et al., 2008), future research reported the PCL-R as being an excellent predictor for recidivism (Skeem et al., 2011; Archer et al., 2013).
Evaluation
While the PCL-R’s utilisation as a predictor for recidivism has established itself as a reliable diagnostic tool for employment in numerous courts of law, it’s inability to capture psychopathy’s spectrum necessitates wariness — despite its nomothetic backgrounds (Venugopal, 2020)
Firstly, the PCL-R’s reliance on correlational data absolves itself from causal inferences. Moreover, that the correlations in Figure 1 are subject to bidirectional ambiguity and a plethora of spurious correlations amongst the plausible confounds that stem from a prison environment decrease Hare’s findings’ validity.
Secondly, the findings’ generalisability are also hindered. Hare’s — and others’ — research stems from male and female prison populations. Not only is this sample limited to those psychopaths who have been caught by the law, attempting to operationalise a construct based only on a subset of individuals which warrant identifying decreases population validity and casts doubt on the veracity of the operationalisation.
Thirdly, the findings suggest that Antisocial characteristics is a pre-requisite of psychopathy, but Hare’s data does seem to point to the contrary (Venugopal, 2020).
Per Figure 1, the Antisocial sub-factor possesses a high correlation of 0.81. However, the sub-factor’s specific traits have much lower inter-rated correlations (0.67 to 0.70). In contrast, the Interpersonal sub-factor’s traits’ inter-rated correlations are in a higher range (0.66 to 0.73), despite itself possessing the lowest correlation amongst the four sub-factors: 0.77.
These values indicate that Antisocial traits are not paramount to the construct of psychopathy. This reported skew could have occurred due to sampling bias; prison inmates often represent a violent subsection of the population (Venugopal, 2020).
Finally, that the PCL-R places a skewed level of importance on an individual’s antisocial behaviour renders it unlikely for one to achieve a high score sans a criminal history — both juvenile and adult (Skeem et al., 2010). This blind spot may function as an impediment in understanding the construct of psychopathy — rendering this approach as pseudo-spectral (Skeem et al., 2011).
Overview
Regardless of the PCL-R’s flaws, it’s employment in the legal world remains a salient characteristic. However, it is paramount to comprehend the difference between identifying psychopathic individuals and identifying psychopathy as a construct.
The aforementioned pseudo-spectral approach to psychopathy has been the radix of a plethora of the PCL-R’s criticisms. Most notably, construct bias is hypothesised to persist amongst the PCL-R’s promoters (Skeem et al., 2010); the checklist’s criticisms swayed as its performance as a predictor for recidivism remains excellent.
Nevertheless, it is vital to agnise that no construct ought to be restricted by the most popular form of operationalisation. The PCL-R’s reputation for being a reliable diagnostic tool stems from studies which do not attempt to evaluate the construct any other way (Skeem et al., 2011).
As such, the PCL-R, as it currently stands, overemphasises Antisocial characteristics and underemphasises Interpersonal characteristics — going against the spectral understanding of psychopathy which Cleckley initially envisioned (Cleckley, 1988).
Conclusion
In fine, the PCL-R's application in criminology benefits from giving less weight to psychopathy's Interpersonal traits. However, this oversight does not further researchers' outlook on the overall construct, thus rendering it an ineffective tool for diagnosing psychopathy.
A suitable respite could evolve in attempts to tweak the PCL-R, or even develop a new method of operationalisation. Such efforts would allow for a more nuanced understanding of psychopathy as a construct, and prevent 'functional psychopaths' from slipping through the PCL-R's cracks.
References
Archer, R. P. (2013). Instruments. Routledge.
BLAIR, J., & al, E. (2005). The Psychopath: Emotion and the Brain. Blackwell.
Cleckley, H. M. (2015). The Mask of Sanity: An Attempt to Clarify Some Issues about the so-Called Psychopathic Personality. Echo Point Books & Media.
Hare, R. D. (2003). Hare Psychopathy Checklist-Revised: 2nd Edition. Multi Health Systems.
Hare, R. D., & Neumann, C. S. (2008). Psychopathy as a clinical and empirical construct. Annual Review of Clinical Psychology, 4(1), 217–246. https://doi.org/10.1146/annurev.clinpsy.3.022806.091452
Leistico, A.-M. R., Salekin, R. T., DeCoster, J., & Rogers, R. (2008). A large-scale meta-analysis relating The hare measures of psychopathy to antisocial conduct. Law and Human Behavior, 32(1), 28–45. https://doi.org/10.1007/s10979-007-9096-6
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Skeem, J. L., & Cooke, D. J. (2010). Is criminal behavior a central component of psychopathy? Conceptual Directions for resolving the debate. Psychological Assessment, 22(2), 433–445. https://doi.org/10.1037/a0008512
Skeem, J. L., Polaschek, D. L., Patrick, C. J., & Lilienfeld, S. O. (2011). Psychopathic personality. Psychological Science in the Public Interest, 12(3), 95–162. https://doi.org/10.1177/1529100611426706
Theodorakis, N. (2013). Psychopathy and its relationship to criminal behaviour. IALS Student Law Review, 1(1). https://doi.org/10.14296/islr.v1i1.1705
Venugopal, P. (2020). To what extent is the Psychopathy Checklist (Revised; PCL-R) effective in diagnosing psychopathy?. Unpublished manuscript.
Vitacco, M. J., Neumann, C. S., & Jackson, R. L. (2005). Testing a four-factor model of psychopathy and its association with ethnicity, gender, intelligence, and violence. Journal of Consulting and Clinical Psychology, 73(3), 466–476. https://doi.org/10.1037/0022-006x.73.3.466
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