Why classifying psychopathy as a mental health problem can be incredibly dangerous

Perhaps the problem is with broader groupings of illnesses and disorders. In which case, we need to re-think our labelling altogether

Last week I joined a discussion panel as part of the Centre for Life’s Science Speakeasy programme for adults. The topic of conversation for its inaugural speakeasy event was psychopathy – a topic that currently fascinates the public, including myself.

As someone who flunked their A-Levels and never made it to university, I have to admit to experiencing a fair degree of imposter syndrome. I was joining a panel of renowned psychopathy experts whose names were pre-fixed with either “Dr” or "Professor". And I think the very fact that I was feeling like this made it clear to me that my score on the psychopath test would be rather low (can anyone imagine Hannibal Lecter or Killing Eve’s Villanelle experiencing imposter syndrome?)

So psychopathy research and lived experience were both out of my reach. I did, however, have a different perspective on psychopathy, which is why I believe I was invited to join. My experience on the topic has been in raising awareness of the significant differences between psychopathy and psychosis – two words that are often easily confused amongst the general public.

So why is this an issue?

Well, there’s a reason we are all talking about mental health stigma, and that’s to enable people to speak out and get help. It’s also to campaign for more mental health services – but the Government seem to keep missing that point…

Back to stigma though. People who experience psychosis, and indeed other mental health problems, are incredibly vulnerable. Yet the world often assumes they might be violent or frightening. This couldn’t be further from the truth.

Psychopaths, however, can indeed be violent and frightening. And if they’re not – if they are successful members of society - they are unlikely to feel vulnerable or concerned about psychopathy stigma. This is because the personality traits that combine to form psychopathy include a lack of empathy, grandiosity and shallow emotions.

So I’m not convinced we need to be concerned about whether or not psychopaths experience stigma. But the problems caused for people experiencing psychosis stigma are immense. Feelings of shame that may stop them seeking help; isolation (just check out the number of people in this survey who said they were unlikely or unsure whether they would remain friends with somebody living with schizophrenia – shocking!) In addition to that, we’ve seen communities campaigning against mental health services being located in residential areas because of a fear of violence or antisocial behaviour. A ridiculous myth that is still, sadly, believed by many.

This is why, in my mind, psychopathy should not be seen as a mental health problem. And yet this was a debate that split the panel down the middle last week.

Dr Luna Centifanti, a senior lecturer in Psychological Sciences at the University of Liverpool challenged my view. She said: “Psychopathy is a mental illness since it's associated with disordered thinking, emotions, and behaviour. According to psychological research, people with psychopathy lack empathy and guilt, have emotions that are not as strong as much of the typical population, and they fail to understand and appreciate the emotional experience of others. Their ability to know when someone is afraid, for example, is compromised. Thus, their response to someone else's distress will be inappropriate.”

Luna (we are now on first name terms since discovering a shared love of beer and punk rock) also said that there are neurobiological impairments that affect people with psychopathy and their ability to make moral decisions and that people with psychopathy, in some ways, can't help who they are.

This is a fair comment – especially since I was debating the issue with a doctor (imposter syndrome again!) It seems it isn’t the fault of the person classed as a psychopath – they can’t help how their brain works. But does that make them vulnerable?

My view is that their lack of empathy and inability to judge another’s emotions makes the other person vulnerable – not the psychopath.

However, in mental health, it’s the other way around.

So given the science involved in this, how should we, as a society, classify psychopathy?

Luna had an interesting take on this. She said: “I agree that the human value of a label can clash with the science value to a label. We typically say that psychopathy is a research diagnosis, not a clinical one, that the label helps us study people with particular traits who continue to violate the rules.

“Legally, some argue that personality disorders, like psychopathy, should be included in the Mental Capacity Act of 2005 – a legal framework which is used to make legal assessments about people's capacity.”

Luna also explained that many mental health professionals argue that personality disorders are not adequately represented in the Mental Capacity Act – most notably psychopathy and Borderline Personality Disorder (BPD). This is despite the substantial difficulties people with these disorders have in using and weighing information for decision-making.

But the classification of personality disorders is troubling in itself since psychopathy incorporates dangerous individuals, and people diagnosed with BPD are, as with other mental health problems, extremely vulnerable.

So what’s the answer?

Maybe the problem is more complex than simply whether or not psychopathy should be seen as a mental illness. Perhaps the problem is the broader labelling of mental illnesses and disorders? Why should we lump BPD in the same category as psychopathy? I don’t believe we should.

Perhaps we need to re-think our labelling altogether. Could we not remove BPD and other vulnerable "personality disorders" from the personality disorder category? Can we not more fully integrate them into the wider mental health category?

As for psychopaths – I really don’t think they’ll mind if they’re labelled as "personality disordered". Saying that, I’m always happy to be challenged by the experts.