The psychopaths we recognize from TV shows and movies are typically portrayed as barbaric murderers or serial killers. This exaggerated depiction may actually impede our understanding of psychopaths and how this disorder should be treated. Psychopathy is a personality disorder in which an individual may exhibit a lack of empathy, guilt, and a sense of responsibility, as well as heightened impulsivity. These psychological symptoms will typically arise during childhood. While it is highly recommended that treatment is administered during childhood to reduce violent tendencies, psychopathy cannot be cured. To have a full understanding of the resilience of psychopaths to treatment, we must first explore the neural circuitry that gives rise to psychopathy. 

A prominent theory behind psychopathy is that the amygdala of psychopaths is impaired, resulting in the inability to properly process and recognize emotions in others, specifically sadness and fear. Both of these emotions are crucial for experiencing empathy. While this theory does provide an explanation for a psychopath’s aggressive nature, it does not account for the role of other brain regions, such as the frontal cortex, that play a crucial role in the cognitive experience of emotion. 

The frontal cortex is essential for higher order processing, such as reasoning, working memory, motivation, and executive control. Adrian Raine in 2005 published a study that discovered a decreased amount of neurons in the frontal lobes of “unsuccessful” (convicted) criminal psychopaths. This study also drew a correlation between low prefrontal gray volume and arrogance, deceptiveness, impulsivity, and instability, thus providing a clear involvement of the frontal lobe impairment in psychopathy. 

The corticolimbic system consists of the hippocampus, amygdala, anterior cingulate cortex, and dorsolateral prefrontal cortex. These subregions are responsible for attention processing and emotional experiences. It has been established previously that psychopaths display an abnormality in the way their neurons communicate with each other within the corticolimbic system. It was also observed that the corticolimbic system played a lesser role in acting as a central hub for the overall flow of information throughout the brain. This indicates that psychopaths are unable to integrate emotion and morality when making their decisions. 

At a psychopath’s core, they are unable to experience empathy or understand another individual’s emotions. It is commonly believed that psychopaths are incurable and unable to be treated, and perhaps this may be correct. As Kiehl explains, talking therapies are ineffective as they are frequently sought after by individuals who are willing to receive help because they are aware of their problem, disorder, or illness. Psychopaths, on the other hand, are unaware that they have a psychological problem and thus will not only refuse treatment, but will convince others of their well being and satisfaction. Pharmacological alternatives may also be considered, although medication may not target a psychopath’s cognition and internal values. While many studies have shed light on the neural mechanisms and brain regions likely responsible for psychopathy, there is still much to be uncovered. Although the existing pool of results and analyses is quite shallow, there remains optimism that experimentation and treatment options improve as more awareness of psychopathy being a neurological disorder spreads.

References:

Brown, Darcy et al. “Clozapine: an effective treatment for seriously violent and psychopathic men with antisocial personality disorder in a UK high-security hospital.” CNS spectrums  vol. 19,5 (2014): 391-402. doi:10.1017/S1092852914000157

Engelhaupt, Erika. “The Most (and Least) Realistic Movie Psychopaths Ever.” Science News, ScienceNews, 2014, www.sciencenews.org/blog/gory-details/most-and-least-realistic-movie-psychopaths-ever

Freeman, Rhonda. “Treatment of Psychopathy: Neuroinstincts: Dr. Rhonda Freeman.” Neuroinstincts, Neuroinstincts, 2013, neuroinstincts.com/treatment-psychopathy/. 

Kiehl, Kent A, and Morris B Hoffman. “THE CRIMINAL PSYCHOPATH: HISTORY, NEUROSCIENCE, TREATMENT, AND ECONOMICS.” Jurimetrics vol. 51 (2011): 355-397.

Reidy, Dennis E et al. “Reducing psychopathic violence: A review of the treatment literature.” Aggression and violent behavior vol. 18,5 (2013): 527-538. doi:10.1016/j.avb.2013.07.008

Skeem, Jennifer L et al. “Psychopathy, treatment involvement, and subsequent violence among civil psychiatric patients.” Law and human behavior vol. 26,6 (2002): 577-603. doi:10.1023/a:1020993916404

Tillem, Scott et al. “Psychopathy is associated with shifts in the organization of neural networks in a large incarcerated male sample.” NeuroImage. Clinical vol. 24 (2019): 102083. doi:10.1016/j.nicl.2019.102083