Top positive review
Informative, Albeit Disturbing Read. Would Love a 2018 Version!
Reviewed in the United States on August 13, 2018
Imagine waking up one day without the usual anxieties of aligning to social mores and laws. The past and future consequences of a risky endeavor seem insignificant. All that seems to matter is your set of personal desires, regardless of what others want. Expressions of emotion and empathy seem foreign, but you imitate them by watching movies. You "know the words, but not the music." You believe that others are either pawns to be played for your own gain, and/or others are seeking to con you. You may continuously violate social norms and laws to obtain what you want (e.g. embezzelment) and not feel remorse for your actions. This is an extreme example of what it is "like" to be a psychopath, according to Without Conscience. Mind you, this is a very vague example. Armchair diagnoses of psychopathy are unethical and impossible for non-clinicians, even after reading this book.
Robert D. Hare's "Without Conscience" is a chilling book. In his practice and research, he has developed the Psychopathy Checklist-- a tool that is reliable and valid with proper usage. Without Conscience argues that both genetics and environment play a role in the expression of psychopathy, but psychopaths are not created by poor parenting alone. However, a less violent environment will tend to produce less violent expressions of social deviance in psychopaths. Hare explores neuroscientific explanations for psychopathy, but answers from the literature (as of the latest edition of Without Conscience) are still not entirely clear. He argues that there is not necessarily frontal lobe damage in psychopaths, but there is absolutely a deficiency in prefrontal cortex functions in psychopaths (e.g. empathy, executive functioning, judgment, and planning). Further, there may be a link between decreased lateralization of verbal centers in the brain and psychopathy (more effort for the two lobes to communicate in two hemispheres versus one). This hypothesis of decreased brain lateralization may explain the disjointed, confabulated stories from psychopaths that only seem to make sense when the listener is "taken" with superficial charm and emoting (with exaggerated hand and facial expressions).
These "nature AND nurture" theories make sense, as genetics and other biological factors can play a strong role in the development of DSM conditions. Think about individuals who have experienced hardship yet manage not to lash out at others as a result. I feel conflicted regarding use of the term "psychopathy," but Hare asserts it is more serious than a diagnosis of Antisocial Personality Disorder.
This book was written in the 90s and was based on the DSM-IV, yet still seems relevant today. Now that it is 2018 and the DSM has been revised to a fifth edition, I would love for Hare to update this book. Imagine potential sections on internet culture, more recent literature reviews on neuroscience, and further analysis of psychopath vs. non-psychopath crime statistics from Canada and the U.S. I do wonder how often the Psychopathy Checklist is used today, and if research still supports its validity and reliability. It seems like a valuable tool that should be used in many therapeutic settings (not just forensic).
As someone in the mental health field, I am truly reluctant to label individuals with such serious diagnoses. Today, clinicians are advised to diagnose personality disorders ONLY after extensive, specialized testing and a long period of time. Hare advocates for the diagnosis of psychopathy to protect potential victims, help make short-term changes in destructive individuals via specialized programs/early intervention, and remove blame from confused/frustrated/victimized spouses, parents, business partners, etc.
It is important to note that individuals sensitive to strong content may want to skip over some sections. A few anecdotes on violent individuals are quite disturbing/graphic. Both men and women can do the unthinkable. Prognosis for psychopathy is poor as of this latest edition. Hare advises parents with minor children (suspected of psychopathy) to try their best with specialists. With other potential psychopaths, Hare recommends walking away, self-protective measures and damage control.
As an aside, I will note that this book pairs well with other works on psychology (Why Does He DO That? By Lundy Bancroft, The Verbally Abusive Relationship by Patricia Evans, George K. Simon's work, Tracy Schorn's book/Chump Lady blog, resources from the Domestic Violence Hotline, and more). One does not have to be a psychopath to treat others poorly. Regardless of diagnoses, victims of such treatment are not to blame. If you suspect someone in your life is not treating you with the respect you deserve, you do not have to set yourself on fire to keep the person warm. Someone can do violent, mean, terrible things (maybe not to the degrees described in this book), yet still be in great psychological pain. Those who want help will often seek help.