Psychopath

[Namechange50008]

I've just learnt apparently one per cent of the population is a psychopath.
But generally not in the film way (e.g American Psycho) but in an actual mental health way (e.g high impulsivity/low boredom threshold/egocentric/superficially charming/liars).
There's the Hare Checklist which I've got really into.
But what it boils down is that they don't seem to feel emotions.
I can't comprehend this - I get angry and sad and anxious and all the emotions - and am fascinated. One per seems huge.
Does anyone think they know a psychopath? Genuinely? This isn't an AIBU BTW. I'm honestly just really interested.

I know one definite psychopath, and possibly one other. The first one was a friend at uni, she nearly ruined my life. I studied psychopathy at uni, so I was good at spotting it, but not till after the events.

I've never met a psychopath (as far as I know) but I've met a fantasist / Walter Mitty type at work and he was an utterly bizarre character. When anybody gave him 5 seconds of time - in the lift, at the coffee machine, on the way to the toilet - he'd launch into the most staggering, unbelievable stories, which mounted up on each other until people were practically laughing out loud and he was just oblivious.

For example, on Monday he might see you at the coffee machine and say something plausible like "I used to be in the Armed Forces" and you'd listen to that story. Then he might catch you in the lift on Tuesday and say that he'd been shot twice by gangsters. Ok. Wednesday, he once got married in Las Vegas, and the bride's ex-H turned up and ran his car off the road, and he ended up throwing the guy from the top floor of a hotel. It just went on and on like a Liam Neeson movie, he couldn't stop himself. It was an absolute compulsion. On one occasion he was talking to one of our colleagues who has a physical disability and - mortifyingly - he started saying that his knees were screwed together with steel plates and that he had a limp, too. And then he limped for days. He didn't even try to be convincing, I mean a child could make up those stories. I've never met anyone else like that.

You are not brainless monsters. I guess certain portrayals and perceptions must be exhausting. There is good and bad in all of us, and we have all done things that we are not proud of.

I am pretty sure my surgeon in London is a psychopath, I kind of recognise them too after my experience, and he is an amazing man, world class and saved my life. I was one of many hundreds/thousands that he saved. Precision, clarity and lack of emotion can be invaluable. I don’t suppose you care about my opinion much, but for balance i thought it was important.

He could well be, or else he just learned how to compartmentalise for different means.
No, thank you. I understand where the stigma stems from but it can be so irritating.

When he described my major surgery as mere carpentry I had a good idea that he was suitably emotionally removed from the reality/risk 💪🏻

Depends. It sounds dismissive at first but sometimes that's exactly what people want to hear before a procedure.

I'd happily have a psychopath as a surgeon. I think it's really a really helpful scenario in which to have someone who is not too emotionally involved because it allows them to get on with the job at hand methodically and precisely.

I will absolutely read all of this thread but haven't yet.

The Hare test is still the gold standard but it needs to be used in conjunction with as much of a person's background as possible. The diagnostic score is 30+ so don't worry if you're getting 25 😁

The psychopath has a different brain as seen in fMRI. The entire limbic system is compromised. The frontal lobe is missing grey matter (see Phineas Gage re: frontal lobe deficits) the amygdala is smaller (the fear centre) which is why they take more risks and tend not to fear consequences. The hypothalamus which is the reward centre of the brain is bigger so they partake in reward seeking behaviour, even if the reward involves hurting a person.

Obviously the higher the score, the more pronounced these deficits are. There are more of them but I'd be here all day.

One diagnosis I will argue the toss about is Ian Brady. He doesn't fit the criteria for the generally accepted psychopath diagnosis. He was a nihilistic sadist.

This isn't just hot air (well, it might be!) I've written a thesis on personality disorders and psychopathy and essays almost dissertation long on Brady.

That sounds very interesting @bottleofbeer - much more so than my dissertation which was as boring as it was long.
Two points:

• if you're getting 25, you're probably not worrying so your advice is moot.

- fuck me, you should be worrying! The only person I've ever met who I would say I knew intimately enough to even suspect could potentially be a psychopath (and this is, of course, a guess) was actually very agreeable, much more so than people who clearly weren't. There was more to it, of course, but he was not some dead-eyed maniac. And he yawned.

Genuine question. Why do you think a surgeon would be emotionally invested anyway? Surely to any surgeon in this scenario you are just another patient/ number?

@Namechange50008 The one in my case, that is a guess too, but narcissist, also yawned and expressed most things the same.

The dead eye look that I saw was more along the lines of, they looked different from what they were an hour before. Similar to someone's eyes expressing anger but without the anger or anything else associated, just the eyes but talking and acting normally. So to me I can see they look different, even around the eyes but to strangers they may not notice something off because they have no reference from before, if that makes sense.

Good doctors of all kinds learn to find ways to remain empathetic while also maintaining some distance, or they would go nuts.

But in the medical community, surgeons are known to very typically have certain personality traits. One is a kind of supreme confidence - cutting into a persons body, sawing through bone, etc, when it's not some minor procedure, is something many people couldn't do well. They would be paralyzed by the possibility of making things worse. Especially when you are talking about more experimental surgeries or situations where decisions have to be made very quickly.

My suspicion is that it is the lack of anxiety about risk that is really important in these scenarios. Of course you don't want someone who is a cowboy, but it can be a fine line.

Surgeons are also well known for not being the best at being able to understand the wider patients goals, where often the patient isn't quite sure what questions to ask or how to understand the implications of surgery. Surgeons often tend to be so focused on the surgery they forget to ask themselves if it will really serve the patients needs.

That's all a generalization of course. Some people have none of those traits but are still able to do that kind of work under pressure. They just compartmentalize well.

V.interesting thread especially around nature / nature. There was also a thread some years ago that started with the OP experiencing a chilling response to a male who simply walked past her in a supermarket. Another post also referenced someone who experienced the same when entering a prison cell (can't recall the circumstances they were there themselves bit that is irrelevant) where a prison officer was sitting with an inmate. She found out later that the prisoner was Myra Hindley. The thread also referenced the book, gift of fear which amongst other aspects validates "gut feelings" that we rationalise as an aspect of socialisation which doesn't always serve us well to respond to threats to our wellbeing.

I'm interested to hear your thoughts on Brady. He had clinical diagnoses of NPD and ASPD and has always been regarded as a textbook psychopath in terms of most things I've read. Essentially a case of a severe PD that was complicated later by psychosis / schizophreniform symptoms that seemed to emerge because he couldn't cope in prison. I think it is likely he was always psychotic to a degree (MH wrote that he used to talk to trees etc) but not to any level that impaired responsibility. He was both psychopathic and psychotic IMO.

Brady concealed and obfuscated to an extreme degree. He wasn’t easy to diagnose, and the ‘understanding’ of his mental state evolved through the years. He didn’t actually present as typically psychopathic, and some of the symptoms he manifested were incongruous with psychopathy.

this is interesting reading on the subject:
https://www.judiciary.uk/wp-content/uploads/JCO/Documents/Judgments/ian-brady-mh-tribunal-240114.pdf

Psychopath doesn't mean killer and I don't see how making unqualified parallels is helpful.

Many people seem to diagnose and see them at every turn but it's not so hard to think of unemotional people... the average politician? They see and cope well with suffering at every turn. Most people couldn't do that.

I've thought my nephew was a psychopath from a very young age (toddler). He was just "off".

Someone was introduced to him aged about 10 and after said, "I think that kids a psychopath"!

And yes, enjoys hurting animals and a compulsive liar. And definitely believes he is the most important person in the world.

Wow, I bet your thesis is fascinating!

@MouseMinge

I have observed some Surgeons do display traits of autism which bodes well in the theatre environment...highly intelligent, focused, organisational skills, attention to detail etc. The downsides though are not conducive to effective working relationships with staff or patient interaction (this actually will and does have direct impact on how effective their work is)..for example not understanding others, being blunt/rude, not understanding social cues etc.

Psychopathy in surgeons or any health care professional is completely different and wouldn't be admired nor sought after..in fact it would be down right dangerous...No empathy, callous, lack of remorse, lying. The repercussions would be devastating.

@Sheog Do you actually believe that surgeons aren't emotionally invested in their patients?? Just because what? They cut people open or make a shit load of money by doing it? I think it shows a lack of understanding in just how difficult and demanding physically and emotionally their jobs are. Some of the life and death situations they face on a daily and some of the most gut wrenching conversations they have to have with patients and their families would make you think twice.

@honeyrain No, I can’t see how they can be emotionally invested in their patients. It’s a task and possibly a challenge, but it’s not about the person themselves who could be anyone.

To the poster saying about surgeons being emotionally invested in their patients: I’m not a surgeon but I do work in a ‘caring’ profession and I’m absolutely not emotionally invested. Im very good at my job and I strive for the highest standards, but it isn’t out of empathy or caring; it is out of pride in my work and a desire to be the best. Luckily my goals align perfectly with those of my profession and my appreciation of order and perfection means that I want the best for those I work with. Do not confuse that for caring on a deep emotional level though; I care because I am paid to. I would never act detrimentally to those I work with because it goes against my moral code; there is no empathy there running any deeper than a comprehensive understanding of human nature.

@thelinkisdead, I'd take a moral code and comprehensive understanding of human nature over Empathy (capitalised!) any day. It's almost the definition of empathy, isn't it? Theory of mind.

This makes perfect sense

@Sheog most doctors are emotionally invested to a lesser or greater degree. I have a nephew-in-law who is a cardiologist who is emotionally invested in his work. My niece, his wife, is a psychiatrist, equally invested.

@honeyrain I know that surgery is in the top ten professions with the most psychopaths. Of course, we're not talking about serial killers or the totally maladjusted but decent, intelligent people who lack empathy. My guess would be that those with psychopathic tendencies working in medicine are, I would hope, not suffering from comorbidities that could make them a danger to others. Probably lacking in a really good bedside manner but are damned good at their jobs. Of course, when it comes to consultants who have to talk to me about all that ails me I prefer someone without those tendencies!

Well, it doesn’t make sense to me how and why anyone would be emotionally invested. Can you ask them why they feel an emotional connection? I’d be quite interested because I like to understand other perspectives.