Review - The Psychopath Test: A Journey Through the Madness Industry

"The Psychopath Test" quixotically flits between psychological research, Scientology, mental asylums, corporate raiders, and Douglas Hofstadter's "Goedel, Escher, Bach" as Jon Ronson explores our society's relationship with madness.

I chose this book because I've long suspected that a fair bit of psychological research is not particularly reliable. Ronson investigates the gray areas of abnormal psychology and exposes the surprising extent to which psychopathy is socially constructed.

This book shines when Ronson digs into the history of psychology. I loved his account of the creation of the DSM-IV and his retelling of the Rosenhan experiment which caused a crisis in American psychology.

But Ronson's credibility weakens as he drags us on a gonzo journalism tour that includes visits to the Broadmoor prison for the criminally insane, the Scientology headquarters for conducting a vendetta against psychology, and a possibly-psycopathic CEO's Florida mansion. While certainly entertaining, these parts of the book feel disorganized and not particularly compelling as evidence of his main thesis. I found his TED talk to confirm my suspicion of his general flightiness.

He seems to have caught a lot of flack for his bits about Bob Hare's PCL-R Checklist for diagnosing psychopathy. I found Hare's own condemnation of the book unconvincing and thought that Ronson did a good job of highlighting the oddly commercial nature of Hare's research career.

Overall, this is a quick and fun read that raises some interesting questions about our society's handling of mental health. But I have doubts about its overall reliability.

My top highlights below.

1. THE MISSING PART OF THE PUZZLE REVEALED

“She was interviewing a psychopath. She showed him a picture of a frightened face and asked him to identify the emotion. He said he didn’t know what the emotion was but it was the face people pulled just before he killed them.”

There were the weeks I spent trailing the conspiracy theorist David Icke around as he hypothesized his theory that the secret rulers of the world were giant, blood-drinking, child-sacrificing pedophile lizards that had adopted human form. That was a good story.

Yes, there was a missing piece of the puzzle, Douglas Hofstadter was saying, but the recipients had gotten it wrong. They assumed the endeavor was brilliant and rational because they were brilliant and rational, and we tend to automatically assume that everybody else is basically just like us. But in fact the missing piece was that the author was a crackpot.

I thought about my own overanxious brain, my own sort of madness. Was it a more powerful engine in my life than my rationality?

Suddenly, madness was everywhere, and I was determined to learn about the impact it had on the way society evolves. I’ve always believed society to be a fundamentally rational thing, but what if it isn’t? What if it is built on insanity?

2. THE MAN WHO FAKED MADNESS

He works for the British office of an international network of Scientologists called the CCHR (Citizens Commission on Human Rights), a crack team determined to prove to the world that psychiatrists are wicked and must be stopped.

“Where did you get that one from?” I asked Tony. “A biography of Ted Bundy,” Tony replied. “I found it in the prison library.” I nodded and thought it probably wasn’t a great idea for prison libraries to stock books about Ted Bundy.

It is an awful lot harder, Tony told me, to convince people you’re sane than it is to convince them you’re crazy.

I glanced suspiciously at Tony. I instinctively didn’t believe him about this. It seemed too catch-22, too darkly-absurd-by-numbers. But later on Tony sent me his files and, sure enough, it was right there. “Tony is cheerful and friendly,” one report stated. “His detention in hospital is preventing deterioration of his condition.”

3. PSYCHOPATHS DREAM IN BLACK-AND-WHITE

It was the French psychiatrist Philippe Pinel who first suggested, early in the nineteenth century, that there was a madness that didn’t involve mania or depression or psychosis. He called it “manie sans delire” — insanity without delusions. He said sufferers appeared normal on the surface but they lacked impulse controls and were prone to outbursts of violence. It wasn’t until 1891, when the German doctor J. L. A. Koch published his book Die Psychopatischen Minderwertigkeiter, that it got its name: psychopathy.

I know of nothing comparable to what Elliott Barker did,” e-mailed another, Richard Weisman, a social science professor at York University in Toronto who wrote a brilliant paper on Barker
— “Reflections on the Oak Ridge Experiment with Mentally Disordered Offenders” — for the International Journal of Law and Psychiatry.

“That’s an incredibly depressing thought,” I said, “that if you’re in a room and at one end lies madness and at the other end lies sanity, it is human nature to veer towards the madness end.”

Barnes eventually became a celebrated and widely exhibited artist. Her paintings were greatly admired in the 1960s and 1970s for illustrating the mad, colorful, painful, exuberant, complicated inner life of a schizophrenic. “And it got rid of the smell of shit,” Adrian said.

I learned that, fascinatingly, two researchers in the early 1990s had undertaken a detailed study of the long-term recidivism rates of psychopaths who had been through Elliott’s program and been let out into society. Its publication would surely have been an extraordinary moment for Elliott and Gary and the Capsule. In regular circumstances, 60 percent of criminal psychopaths released into the outside world go on to re-offend. What percentage of their psychopaths had? As it turned out: 80 percent. The Capsule had made the psychopaths worse.

4. THE PSYCHOPATH TEST

Hare is influential. Justice departments and parole boards all over the world have accepted his contention that psychopaths are quite simply incurable and everyone should concentrate their energies instead on learning how to root them out using his PCL-R Checklist, which he has spent a lifetime refining.

Their conclusions became the basis for his now famous twenty-point Hare PCL-R Checklist. Which was this:

Glibness/superficial charm
Grandiose sense of self-worth
Need for stimulation/proneness to boredom
Pathological lying
Conning/manipulative
Lack of remorse or guilt
Shallow affect
Callous/lack of empathy
Parasitic lifestyle
Poor behavioral controls
Promiscuous sexual behavior
Early behavior problems
Lack of realistic long-term goals
Impulsivity
Irresponsibility
Failure to accept responsibility for own actions
Many short-term marital relationships
Juvenile delinquency
Revocation of conditional release
Criminal versatility

Wven so, Bob said, psychopaths tend to gravitate toward the bright lights. You’ll find lots of them in New York and London and Los Angeles. The psychologist David Cooke, of the Glasgow Centre for the Study of Violence, was once asked in Parliament if psychopaths caused particular problems in Scottish prisons. “Not really,” he replied. “They’re all in London prisons.”

said, almost to himself, “I should never have done all my research in prisons. I should have spent my time inside the Stock Exchange as well.” I looked at Bob. “Really?” I said. He nodded. “But surely stock-market psychopaths can’t be as bad as serial-killer psychopaths,” I said. “Serial killers ruin families.” Bob shrugged. “Corporate and political and religious psychopaths ruin economies. They ruin societies.” This — Bob was saying — was the straightforward solution to the greatest mystery of all: Why is the world so unfair? Why all that savage economic injustice, those brutal wars, the everyday corporate cruelty? The answer: psychopaths.

“The higher you go up the ladder, the greater the number of sociopaths you’ll find there.”

5. TOTO

In readiness for the impending trial, three women stepped forward to tell prosecutors they had been raped by Constant’s men and left for dead. His fate looked sealed. But he had one play left. From his jail cell he announced on CBS’s 60 Minutes that he was ready to reveal the names of his backers, the mysterious men who had encouraged the creation of FRAPH and put him on their payroll. They were agents from the CIA and the Defense Intelligence Agency. “If I’m guilty of the crimes they say I was,” he told the interviewer, Ed Bradley, “the CIA is also guilty.”

6. NIGHT OF THE LIVING DEAD

“Lions,” said Al Dunlap, showing me around. He was wearing a casual jacket and slacks and looked tanned, healthy. His teeth were very white. “Lions. Jaguars. Lions. Always predators. Predators. Predators. Predators. I have a great belief in and a great respect for predators. Everything I did I had to go make happen.”

He was more in demand than ever, he said, now that a big study he’d coauthored, “Corporate Psychopathy,” had just been published. In it, 203 “corporate professionals” were assessed with his checklist — “including CEOs, directors, supervisors,” Bob said — and the results showed that while the majority weren’t at all psychopathic, “3.9% had a score of at least 30, which is extremely high, even for a prison population, at least 4 or 5 times the prevalence in the general population.”

As I glanced at the phraseology of the research report, dull and unfathomable to outsiders like me, I thought that if you have the ambition to become a villain, the first thing you should do is learn to be impenetrable. Don’t act like Blofeld—monocled and ostentatious. We journalists love writing about eccentrics. We hate writing about impenetrable, boring people. It makes us look bad: the duller the interviewee, the duller the prose. If you want to get away with wielding true, malevolent power, be boring.

7. THE RIGHT SORT OF MADNESS

“So what constituted ‘just mad enough’?” I asked. “Prozac,” said Charlotte. “Prozac’s the perfect drug. They’re upset. I say, ‘Why are you upset?’ ‘I’m upset because my husband’s cheating on me, so I went to the doctor and he gave me Prozac.’ Perfect! I know she’s not THAT depressed, but she’s depressed enough to go to a doctor and so she’s probably angry and upset.” “Did you get disappointed on the occasions you found they were on no drug at all?” I asked Charlotte. “If they were on no drug at all, did that mean they probably weren’t mad enough to be entertaining?” “Exactly,” said Charlotte. “It was better if they were on something like Prozac. If they were on no drug at all, that probably meant they weren’t mad enough.”

8. THE MADNESS OF DAVID SHAYLER

There can be something quite psychopathic about journalism, about psychology, about the art of madness-spotting. After I’d met Charlotte Scott, I consoled myself with the idea that this kind of thing happened only in entertainment–reality TV circles, and I was above it, but the David Shayler story demonstrated that this wasn’t true. Political journalism is no different. I was writing a book about the madness industry and only just realizing that I was a part of the industry.

And we spend our evenings watching Wife Swap and Come Dine with Me and Supernanny and the early rounds of X Factor and Big Brother. TV is just troubled people being booed these days.

9. AIMING A BIT HIGH

Bob was referring to mental hospitals like the one at Coalinga, a vast, pretty, 1.2-million-square-foot facility in central California. The place has 320 acres of manicured lawns and gyms and baseball fields and music and art rooms. Fifteen hundred of California’s 100,000 pedophiles are housed there, in comfort, almost certainly until the day they die

10. THE AVOIDABLE DEATH OF REBECCA RILEY

—DAVID ROSENHAN, “ON BEING SANE IN INSANE PLACES,” 1973 There was only one way out. They had to agree with the psychiatrists that they were insane and then pretend to get better. When Rosenhan reported the experiment, there was pandemonium. He was accused of trickery. He and his friends had faked mental illness! You can’t blame a psychiatrist for misdiagnosing someone who presented himself with fake symptoms! One mental hospital challenged Rosenhan to send some more fakes, guaranteeing they’d spot them this time. Rosenhan agreed, and after a month, the hospital proudly announced they had discovered forty-one fakes. Rosenhan then revealed he’d sent no one to the hospital. The Rosenhan experiment was a disaster for American psychiatry. Robert Spitzer was delighted.

And that’s how practically every disorder you’ve ever heard of or have been diagnosed with came to be invented, inside that chaotic conference room, under the auspices of Robert Spitzer, who was taking his inspiration from checklist pioneers like Bob Hare.

I’d always wondered why there had been no mention of psychopaths in the DSM. It turned out, Spitzer told me, that there had indeed been a backstage schism — between Bob Hare and a sociologist named Lee Robins. She believed clinicians couldn’t reliably measure personality traits like empathy. She proposed dropping them from the DSM checklist and going only for overt symptoms. Bob vehemently disagreed, the DSM committee sided with Lee Robins, and Psychopathy was abandoned for Antisocial Personality Disorder.

In 1980, after six years inside Columbia, Spitzer felt ready to publish. But first he wanted to road test his new checklists. And there were a lot. DSM-I had been a sixty-five-page booklet. DSM-II was a little longer—134 pages. But DSM-III, Spitzer’s DSM, was coming in at 494 pages. He turned the checklists into interview questionnaires and sent researchers out into America to ask hundreds of thousands of people at random how they felt. It turned out that almost all of them felt terrible. And according to the new checklists, more than 50 percent of them were suffering from a mental disorder. DSM-III was a sensation. Along with its revised edition, it sold more than a million copies. Sales to civilians hugely outweighed sales to professionals. Many more copies were sold than psychiatrists existed. All over the western world people began using the checklists to diagnose themselves. For many of them it was a godsend. Something was categorically wrong with them and finally their suffering had a name. It was truly a revolution in psychiatry, and a gold rush for drug companies, who suddenly had hundreds of new disorders they could invent medications for, millions of new patients they could treat. “The pharmaceuticals were delighted with DSM,” Spitzer told me, and this in turn delighted him: “I love to hear examples of parents who say, ‘It was impossible to live with him until we gave him medication and then it was night and day.’

And a surfeit of checklists, coupled with unscrupulous drug reps, is, Gary said, a dreadful combination.

“The USA overdiagnoses many things and childhood bipolar is the latest but perhaps the most worrying given the implications.” Ian Goodyer is a professor of child and adolescent psychiatry at Cambridge University. He — like practically every neurologist and child psychiatrist operating outside the U.S., and a great many within the U.S.
— simply doesn’t believe that childhood bipolar disorder exists.

When Robert Spitzer stepped down as editor of DSM-III, his position was taken by a psychiatrist named Allen Frances. He continued the Spitzer tradition of welcoming as many new mental disorders, with their corresponding checklists, into the fold as he could. DSM-IV came in at 886 pages. Now, as he took a road trip from New York down to Florida, Dr. Frances told me over the phone he felt they’d made some terrible mistakes. “It’s very easy to set off a false epidemic in psychiatry,” he said. “And we inadvertently contributed to three that are ongoing now.” “Which are they?” I asked. “Autism, attention deficit, and childhood bipolar,” he said. “How did you do it?” I asked. “With autism it was mostly adding Asperger’s, which was a much milder form,” he said. “The rates of diagnosis of autistic disorder in children went from less than one in two thousand to more than one in one hundred. Many kids who would have been called eccentric, different, were suddenly labeled autistic.” I remembered my drive to Coxsackie Correctional Facility, passing that billboard near Albany EVERY 20 SECONDS A CHILD IS DIAGNOSED WITH AUTISM. Some parents came to wrongly believe that this sudden, startling outbreak was linked to the MMR vaccine. Doctors like Andrew Wakefield and celebrities like Jenny McCarthy and Jim Carrey promoted the view. Parents stopped giving the vaccine to their children. Some caught measles and died.

As it happened, the pediatric unit at their local hospital — Massachusetts General — was run by Dr. Joseph Biederman, the doyen of childhood bipolar disorder. In November 2008, Biederman was accused of conflict of interest when it was discovered that his unit had received funding from Johnson & Johnson, maker of the antipsychotic drug Risperdal, which is frequently given to children. Although the hospital denied the unit was promoting Johnson & Johnson products, The New York Times published excerpts of an internal document in which Biederman promised to try to “move forward the commercial goals of J&J.” Biederman has said that bipolar disorder can start “from the moment the child opens his eyes.” He has denied the allegations made against him.

The science of children’s psychiatric medications is so primitive and Biederman’s influence so great that when he merely mentions a drug during a presentation, tens of thousands of children within a year or two will end up taking that drug, or combination of drugs. This happens in the absence of a drug trial of any kind — instead, the decision is based upon word of mouth among the 7,000 child psychiatrists in America. —LAWRENCE DILLER, San Francisco Chronicle, JULY 13, 2008

When I asked Robert Spitzer about the possibility that he’d inadvertently created a world in which some ordinary behaviors were being labeled mental disorders, he fell silent. I waited for him to answer. But the silence lasted three minutes. Finally he said, “I don’t know.” “Do you ever think about it?” I asked him. “I guess the answer is I don’t really,” he said. “Maybe I should. But I don’t like the idea of speculating how many of the DSM-III categories are describing normal behavior.” “Why don’t you like speculating on that?” I asked. “Because then I’d be speculating on how much of it is a mistake,” he said. There was another long silence. “Some of it may be,” he said.

11. GOOD LUCK

Britain had five DSPD units — four for men and one, in Durham, for women. That one was called The Primrose. Tony’s was called The Paddock. The official line was that these were places to treat psychopaths (with cognitive behavioral therapy and anti-libidinous drugs — chemical castrations — for the sexual ones), teach them how to manage their psychopathy with a view to one day theoretically sending them back out into the world as safe and productive people. But the widespread theory was the whole thing was in fact a scheme to keep psychopaths locked up for life.

The killer’s name was Michael Stone, and he was a known psychopath. He had previous convictions. But the law stated that only patients whose mental disorders were considered treatable could be detained beyond their prison sentences. Psychopaths were considered untreatable, and so Michael Stone had to be freed. After his conviction for the Russell murders, the government decided to set up a series of treatment centers—“ ‘treatment’ centers,” Brian had said, doing that quotation-mark thing with his fingers — for psychopaths. Soon afterward, the DSPD units were built. And indeed, during the ten years that followed, hardly anybody was ever released from one. Once you were a DSPD patient, there seemed no way out.

Tony was released from Bethlem.