Nevertheless, most psychopaths are not violent, and most violent people are not psychopaths. In the days following the horrific Virginia Tech shootings of April 16, 2007, many newspaper commentators described the killer, Seung-Hui Cho, as “psychopathic.” Yet Cho exhibited few traits of psychopathy: those who knew him described him as markedly shy, withdrawn and peculiar.
Regrettably, the current (fourth, revised) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR), published in 2000, only reinforces the confusion between psychopathy and violence. It describes a condition termed antisocial personality disorder (ASPD), which is characterized by a longstanding history of criminal and often physically aggressive behavior, referring to it as synonymous with psychopathy. Yet research demonstrates that measures of psychopathy and ASPD overlap only moderately.
2. All psychopaths are psychotic. In contrast to people with psychotic disorders, such as schizophrenia, who often lose contact with reality, psychopaths are almost always rational. They are well aware that their ill-advised or illegal actions are wrong in the eyes of society but shrug off these concerns with startling nonchalance.
Some notorious serial killers referred to by the media as psychopathic, such as Charles Manson and David Berkowitz, have displayed pronounced features of psychosis rather than psychopathy. For example, Manson claimed to be the reincarnation of Jesus Christ, and Berkowitz believed he was receiving commands from his neighbor Sam Carr’s dog (hence his adopted nickname “Son of Sam”). In contrast, psychopaths are rarely psychotic.
3. Psychopathy is untreatable. In the popular HBO series The Sopranos, the therapist (Dr. Melfi) terminated psychotherapy with Tony Soprano because her friend and fellow psychologist persuaded her that Tony, whom Dr. Melfi concluded was a classic psychopath, was untreatable. Aside from the fact that Tony exhibited several behaviors that are decidedly nonpsychopathic (such as his loyalty to his family and emotional attachment to a group of ducks that had made his swimming pool their home), Dr. Melfi’s pessimism may have been unwarranted. Although psychopaths are often unmotivated to seek treatment, research by psychologist Jennifer Skeem of the University of California, Irvine, and her colleagues suggests that psychopaths may benefit as much as nonpsychopaths from psychological treatment. Even if the core personality traits of psychopaths are exceedingly difficult to change, their criminal behaviors may prove more amenable to treatment.
Psychopathy reminds us that media depictions of mental illness often contain as much fiction as fact. Moreover, widespread misunderstandings of such ailments can produce unfortunate consequences—as Tony Soprano discovered shortly before the television screen went blank.