Antisocial Personality Disorder Workshop
Antisocial Personality
Disorder and Responsibility:
Scientific
and Ethical Issues
Introduction
Determining the appropriate legislative and institutional
response to individuals with antisocial personality disorder
presents a difficult challenge. For instance, a recent governmental
policy proposal and the consequent programme (Department of Health
1999) have faced many criticisms (Cordess 2002 Eastman 1999, Mullen
1999, Liberty 2002, Gunn and Felthous 2000, Moran 2002) and
ultimately have been rejected.
The workshop on Antisocial Personality Disorder and Responsibility
was held on the 26th of June in York for some 30 UK
based researchers. Its aim was to facilitate a fruitful
interdisciplinary exchange between neuroscientists, psychiatrists,
lawyers and philosophers on the issue of the moral responsibility
of individuals with antisocial personality disorder.
The workshop was divided into three themes:
- Antisocial Personality Disorder: Recent Psychiatric
Advancements and Explanatory Hypotheses
- Regulative developments and antisocial personality
disorder
- Antisocial personality disorder and responsibility
Antisocial Personality Disorder: Recent Psychiatric
Advancements and Explanatory Hypotheses
Assuming that accounts of the responsibility of individuals with
antisocial personality disorder should be constrained by the
explanatory hypotheses advanced in psychiatry, the first part of
the workshop was dedicated primarily to an overview of the research
in this area.
Dr Robert Rogers's talk 'What can neuropsychological investigation
tell us about emotion in psychopathy?' argued that there is
neuropsychological evidence (PET studies) that supports the
hypothesis that psychopaths have altered functioning in the
corticolimbic circuitry that mediate the signalling and regulation
of emotions (disgust, happiness, sadness, fear, surprise,
anger).
Before presenting these results, Dr Rogers offered a useful
introduction to the emergence in the last twenty years of an
influential diagnostic tool known as Psychopathic Checklist (PCL)
(Hare 1980, Hare 1991). The checklist has been used in an
increasing number of psychological, and neurobiological
investigations of the functional deficits and neurobiological
substrates associated with the behaviour and personality traits of
individuals classed as having antisocial personality disorder. This
tool has been elaborated by Robert Hare, who, by operationalising a
clinical notion of psychopathy elaborated by Harvey Cleckley
(Cleckley 1976), has offered a list of 20 items describing
personality and behavioural traits along with professionals can
assign numerical values and when the total is above a certain limit
the subject is classified as psychopath. While the psychometric of
the resulting multidimensional structure is still object of debate
(Cooke and Michie 2001, Harpur, Hakstian, and Hare 1988), it has
clearly emerged that the structure at least factorise in
interpersonal/affective facets and propensity toward a deviant
lifestyle.
Dr Luca Malatesti, responding to Dr. Rogers's talk, advanced some
suggestions concerning the interfacing of empirical research with
philosophical investigations on the ascription of moral
responsibility to psychopaths. Firstly, philosophers should
investigate the viability of PCL-R as scientific construct.
Secondly, they should focus on how requirements posed by account of
moral responsibility, often expressed in terms of
folk-psychological notions, might be undermined by the impairments
so far documented in studies concerning the cognitive/affective
functions of psychopaths. Dr. Malatesti concluded his response by
presenting a new online bibliography (Malatesti 2006).
Regulative and legal developments concerning
‘psychopathy’
The recently abandoned Mental Health Bill contained provisions
that would have made it easier for those coming within the policy
and service construct ‘Dangerous and Severe Personality Disorder’
to be preventatively detained in the absence of real ‘therapeutic
benefit’ offered to them. Professor Nigel Eastman has been involved
in debates about these proposals since their inception, both as a
representative of the Royal College of Psychiatrists and as an
early advisor to the Department of Health on mental health law
reform more broadly. He has also conducted empirical research on
the ethical attitudes of clinicians to ‘preventive detention in the
absence of therapeutic benefit’ and scholarly ethical and legal
research within the field. He gave a brief recent historical
account of the development of relevant mental health legislation in
England and Wales. He then described the impact of the abandoned
legislative proposals, now essentially repeated in the intention to
amend the Mental Health Act 1983, as very small forensic tail
wagging a very large general mental health dog. That is, the debate
about how socially to ‘manage’ those with DSPD, for example through
‘health’ or the criminal justice system, has overshadowed and
unduly influenced the debate about what should be the shape of
mental health legislation more broadly. One of the major themes of
his presentation reflected the concern that such legal changes will
result in psychiatrists being drawn into fulfilling a
non-therapeutic, quasi-judicial role on behalf of the State, which
ought more properly to be the function of the criminal justice
system. He also expressed scepticism about whether the legal
amendments still proposed would be effective in protecting the
public beyond consideration of DSPD, that is in relation to the
mentally ill. Within all of this he discussed the tension inherent
in such proposals between protecting the public and respecting the
civil liberties of those who might be preventatively detained under
the amended legislation.
The legal and moral responsibility
of psychopaths
In recent years, philosophers have put forward many
arguments about the legal/moral responsibility and competence of
'psychopaths' (Benn 1999, Benn 2003, Duff 1977, Greenspan 2003,
Smith 1984). These arguments rely upon philosophical accounts of
moral responsibility that require the integrity of faculties such
as moral understanding (the capacity to distinguish right from
wrong), and moral motivation (acting or deciding to act on the
basis of moral understanding). The talks in this section of the
workshop presented an array of these lines of reasoning.
Professor Duff, rehearsing some of the argumentative strategies
used in Duff 1977, in his talk entitled 'Psychopathy as Rational
Incapacity', argued that given their emotional impairments and lack
of concern for others, psychopathic offenders lack the rationality
required for sharing a certain form of life. Thus they lack
moral understanding and thus they are not morally responsible.
Moreover, given that being an adequate recipient of punishment
requires moral understanding, psychopaths are not legally
responsible.
Professor Matravers, in his response to Professor Duff entitled
'Psychopathy and Moral Responsibility, endorsed the claim that
psychopaths cannot be deemed responsible for their offences;
however he disagreed with aspects of Professor Duff's argument.
Dr Rogers claimed that from the point of view of clinical practice
individuals that satisfy the PCL-R diagnosis of psychopathy do not
appear to satisfy the notion of psychopathy used by Professor Duff.
Professor Duff clarified that his notion was an attempt to
explore the logical space of the practices. Moreover, Professor
Eastman has urged that philosophical accounts of the moral
responsibility of psychopaths should also offer methodological
indications of how it can be established in the professional
setting of the expert verdict.
Dr Maibom, in her talk entitled 'Moral Motivation in Psychopathy
and Acquired Sociopathy' focused on the philosophical debate
concerning the nature of moral motivation. Some authors have argued
that the lack of moral motivation of psychopaths might be due to
their emotional impairments that affect their capacity for empathy
(Nichols 2004). On the basis of empirical evidence from studies
about empathy she defended the idea that moral motivation is also
related to rational capacities. Moreover, as she has argued in
Maibom 2005, this authorises the idea that problems in the moral
motivation of psychopathic offenders might derive from certain
cognitive rational shortcomings well documented in the
psychological literature.
Conclusion
The workshop showed that fruitful philosophical work on the
responsibility of offenders classified as having antisocial
personality disorder might derive from focusing on the specific
notion of psychopathy that has emerged in the last few
years.
In the light of this, the organisers of the workshop invited the
speakers to write a book that would help to articulate a
philosophical account of the moral responsibility of psychopaths on
the basis of the recent scientific advancements. This book will
offer a self-contained introduction of the advancements concerning
the diagnostic tools, functional impairments and neurobiological
correlates of psychopathy. In addition, it will contain chapters on
the historical roots of the debate concerning the social response
to individuals with psychopathy. Finally, there will be chapters
that will illustrate the state of the art of the philosophical
discussion on the ascription of moral responsibility to the
psychopath.
References
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Psychopath', Philosophy, Psychiatry & Psychology, 6,
1: 29-39, 1999
Benn, P. 'The Responsibility of the
Psychopathic Offender: Commentary on Ciocchetti', Philosophy,
Psychiatry & Psychology, 10, 2: 189-192, 2003
Cleckley, H. M. The mask of sanity : an
attempt to clarify some issues about the so-called psychopathic
personality, St. Louis (Mo): Mosby, 1976
Cooke, D. J. and C. Michie 'Refining the
Construct of Psychopathy: Towards a Hierarchical Model',
Psychological Assessment, 13: 171-188, 2001
Cordess, C. 'Proposals for Managing
Dangerous People with Severe Personality Disorder: New Legislation
and New Follies in a Historical Context', Criminal
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Office, 1999
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1999
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2003
Gunn, J. and A. R. Felthous 'Politics and
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Checklist-Revised, Toronto: Multi-Health Systems, 1991
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Liberty 'Draft Mental Health Bill:
Liberty Response to Deparment of Health Consultation Paper', 2002.
Available at: http://www.liberty-human-rights.org.uk/pdfs/policy02/sept-2002-mental-health.pdf
Maibom, H. L. 'Moral Unreason: The Case
of Psychopathy', Mind and Language, 20, 2: 237-257,
2005
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http://www.hull.ac.uk/php/pislm
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Unethical', British Medical Journal, 319: 1146-7, 1999
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the Natural Foundation of Moral Judgement, Oxford: Oxford
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