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PSYCHOPATHY AND THE BIOPSYCHOSOCIAL MODEL
âYou stabbed him [Slaboszewski] once through the heartâ, and only two days earlier Slaboszewski had texted his friend to the effect âthat life was beautiful now that he had you as his girlfriendâ (Justice Spencer, 2014, p. 2). This was the first of a series of murders that Joanne Dennehy would go on to commit during a 10-day cold-blooded violent spree. According to court transcripts, Dennehy manipulated and lured her victims, as well as committing villainous random violence. Although Dennehy committed the acts for her own hedonistic pleasure, she used the help of Gary Stretch, a seven-foot-three-inch ex-convict, who had become infatuated with Dennehy, so much so he would do anything to help her satisfy her taste for violence. After luring and stabbing Slaboszewski in the heart, Dennehy temporarily stored his body in a wheelie bin, until she had the means to rid of it permanently. Dennehy could not keep her murder a secret, boastfully inviting Georgina Page, a 14-year-old neighbor she had recently befriended, to see the body in the wheelie bin. Recounting to psychiatrists why she had committed the first murder, Dennehy ruthlessly stated, âI wanted to see if I was as cold as I thought I was. Then it got moreish and I got a taste for itâ (Spencer, 2014, p. 17). In order to dump the body, Dennehy needed a car. She convinced and borrowed money from her landlord who would soon become her third victim. Two days had passed since the first killing. Dennehy and Stretch took a taxi to purchase a car so they could dump Slaboszewskiâs body on the outskirts of Peterborough in England. After dumping Slaboszewskiâs body, Dennehy killed her housemate John Chapman by stabbing him once in the neck and five times in the chest. Dennehy later reported that she killed Chapman because he walked in on her while she was in the bath. Chapmanâs carotid artery was severed, and his heart was penetrated with severe force. None of the sustained injuries indicated Chapman made any attempt to defend himself, and with a blood alcohol level four times greater than the driving limit it was likely Dennehy attacked Chapman as he lay asleep in the early hours of Good Friday morning.
Next, Dennehy killed her landlord, Kevin Lee, a 48-year-old husband and father. Over the period of several months, Dennehy had befriended Lee, telling him how she had been severely abused as a child, and served many years in prison for killing her father. This was false. There is no evidence that Dennehy was abused as a child, and her father is still alive today. Out of compassion and desire, Lee employed Dennehy at his property letting business and provided her accommodation. Lee and Dennehy became close over the months, and reportedly engaged in sadomasochistic sex games. The two were so close that Dennehy confided in Lee about her first murder. After inviting Lee to engage in sexual activities, Dennehy stabbed Lee five times in the chest, puncturing both lungs and his heart. Now having two bodies to dispose of, Dennehy recruited Stretch and another infatuated admirer, Leslie Layton, to help get rid of the bodies. As a final act of humiliation, Dennehy dumped Leeâs body dressed in a black sequined dress and positioned the body so that the buttocks lay bare and exposed facing upwards. After killing three men and dumping their bodies, Dennehy and Stretch fled the area. Several days later, the two were in East Anglia on the prowl for Dennehyâs next victims. Spotting a man walking his dog, Stretch asked Dennehy, âWill he do?â (Spencer, 2014). Dennehy jumped out of the car and approached Robin Bereza from behind, stabbing him in the back and then in the right upper arm. When Bereza turned, Dennehy said, âI want to hurt you, I am going to fucking kill youâ. After Bereza had put up some resistance to the attack, and with another car approaching, Dennehy calmly retreated and left the scene. Feeling unsatisfied with the failed attack, Dennehy sought out another victim, again an older man walking his dog, 56-year-old John Rogers. Dennehy approached Rogers from behind, stabbing him in the back, as he turned around Dennehy continued to repeatedly stab him. As Rogers fell to the ground, the stabbing continued. Rogers lay on the ground, dying from 30 stab wounds. Dennehy picked up the dog and left the scene. Fortunately, both Rogers and Bereza survived the attacks, and minutes after leaving the scene Dennehy and Stretch were caught by police. On February 24, 2013, before sentencing Dennehy to life in prison, Justice Spencer stated:
(Spencer, 2014, p. 1)
To which Dennehy shouted from the docks while laughing, âBollocks!â (Hamilton, 2014; Spencer, 2014; Wansell, 2016). Dr. Farnhamâs psychiatric assessment showed Dennehy suffered from paraphilia sadomasochism (giving or receiving pleasure through acts of pain or humiliation) and was a psychopath, characterized by superficial charm, callous disregard for others, pathological lying and diminished capacity for remorse (Spencer, 2014, p. 16).
Dennehy encapsulates what it means to be psychopathic; however, not all serial killers are psychopathic, and not all psychopaths are serial killers. It is estimated that the prevalence of psychopathy in the general population is 1.2% (0.3â0.7% in women and 1â2% in men; Neumann & Hare, 2008; Patrick & Drislane, 2015). Although small in number, psychopaths are responsible for 30â40% of all violent crimes, and their violence is more sadistic and severe. There is no surprise then that 93% of psychopaths are either in prison or on parole/probation (Kiehl & Hoffman, 2011). This propensity to violence and criminality makes psychopathy one of the costliest psychiatric disorders, with estimates in the US nearing $460 billion every year; twice the cost of smoking or obesity (Kiehl & Hoffman, 2011; Kiehl & Sinnott-Armstrong, 2013, p. 1). Once caught and incarcerated, psychopaths continue to pose a high risk of prison violence and general misconducts, often emerging as inmate leaders (DeLisi, 2016; Schrag, 1954; Thomson, Towl & Centifanti, 2016). Once released from prison, psychopaths are more likely than other criminals to recidivate (Olver & Wong, 2015). There is no wonder then that psychopathy has become one of the most widely valued clinical constructs in the criminal justice system, and often used in conjunction with violence risk assessments, as well as being central to theories of crime (see DeLisi, 2016; Vaughn & DeLisi, 2008).
Psychopathy is characterized by a constellation of personality and behavioral traits that offer many advantages to perpetrating crime. For instance, the psychopath is able to use others by conning and manipulating them, using her self-centered confidence, superficial charm and charismatic personality. Getting someone to do what she wants is the tip of the iceberg. Without the ability to feel empathy or remorse, and the callous equanimity and desire to hurt others, she is truly an extraordinarily damaging perpetrator. Not only does she display personality traits that help deceive her victims and accomplices, and the inability to let emotions stand in the way of her goal, she is willing to take risks without the concern of consequences, these may be impulsive risks, but always motivated by a self-indulgent goal. There is no surprise, then, that she has a long record of criminal activity and an extensive history of juvenile behavioral problems, and without remorse or guilt and an incapacity to take responsibility for her actions, she will go on to be a lifetime career criminal, regardless of being imprisoned. Even during court and parole hearings, the psychopath continues her manipulative and charming parade. Psychopaths are more likely to attempt malingering (Gacono, Meloy, Sheppard, Speth & Roske, 1995) and to receive a shorter sentence for their crime (Häkkänen-Nyholm & Hare, 2009), and twice as likely to convince parole boards to grant them conditional release (Porter, ten Brinke & Wilson, 2009).
Given that this fairly small population are responsible for almost half the violent crimes committed, understanding the disorder to treat psychopaths has become a pivotal endeavor towards decreasing the number of victims and the massive financial burden on society. A great body of research has been conducted since the 1980s, with biological sciences showing rapid development in the past 15 years. This research has yielded momentous information on the understanding of psychopathy â etiology, correlates and treatment. Unfortunately, the study of psychopathy is mostly discipline-specific, and interdisciplinary research is sparse. Yet, it is widely recognized that interdisciplinary research is vital to increasing our understanding of psychopathy. Therefore, exploring the individual and interactive effects of biological, psychological and social factors will provide a more refined knowledge of the etiology, development and correlates of psychopathy, which will ultimately lead to improvement in treatment efficacy.
The biopsychosocial model
The biopsychosocial model is broad and ambitious, applying a multidisciplinary view that mental illness is attributed to the individual and interactive contribution of biological, psychological and social factors. The biopsychosocial model employs a truly integrative approach to understanding psychiatric disorders for forensic practitioners and researchers. However, even though there has been support for multidisciplinary research (Stoff & Susman, 2005), there has been little discussion or research on the biopsychosocial model since its development (Farrington, 2006). Part of the failure of the biopsychosocial model to take hold is the lack of specificity in the combination of social, psychological and biological factors that contribute to a disorder. Even with this limitation, at present, the biopsychosocial model remains influential to most mental health practitioners (Davies & Roache, 2017), albeit with little clarity. Despite it being over 10 years since Farrington (2006) proposed that the time is âripe for Western countries to mount an ambitious coordinated program of research on psychopathy, focusing on international multidisciplinary collaboration and aiming to train a new generation of biopsychosocial researchersâ (p. 331), there is still very little discussion on the role and importance of the biopsychosocial model in understanding and treating psychopathy.
The aim of this book is to draw together a coherent summary of psychopathy research from multiple disciplines that has occurred over the last 30 years. This research is scattered among handbooks and scientific journals, with only a handful integrating the findings using a biopsychosocial approach. Chapter 1 will deliver an outline of the biopsychosocial model, its history, strengths and critiques, and a case study application for forensic psychology. Chapter 2 provides the reader with a background of the history, the main theories, and methods of assessment of psychopathy. To grasp the value of psychopathy as a construct in forensic psychology, Chapter 3 will critically evaluate the link between psychopathy and crime. An ideal starting point to recognize that psychopathy is a disorder of complex biopsychosocial interactions, Chapter 4 will review the genetic and environmental link in the development of psychopathy. The subsequent chapters each cover a comprehensive review of the biological (Chapter 5), psychological (Chapter 6), and social (Chapter 7) risk factors for psychopathy, as well as its correlates. These chapters highlight the importance of multidisciplinary research and the use of the biopsychosocial approach to understanding psychopathy. Lastly, Chapter 8 will discuss the limited amount of research that has integrated at least two of the biopsychosocial domains, and provides a discussion on the importance of applying the biopsychosocial approach in treatment.
The development of the biopsychosocial model
Before the biopsychosocial model was introduced, the biomedical model was used in full swing. The biomedical model is neatly packaged for the practitioner â disease is fully accountable by measurable biological (physiochemical) deviations from the norm. Further, disease is managed independent of social behavior, and atypical behavior is understood by biochemical or neurophysiological processes. Using the biomedical framework, psychological and social factors were not considered important for understanding and treating disease. Although proponents of the biomedical model focus on the physical scientific principles as the modelâs unwavering strength, Engel (1977) pointed out that the biomedical model was likely rooted in theology as much as it was with science.
Over 500 years ago, the Christian church first allowed the dissection of the human body for scientific reasons, with one important caveat â no associations could be made between the human body and the human mind or behavior. In the view of the church, the human mind and behavior were the responsibility of the church because they were more to do with the soul and religion (Engel, 1977), whereas the body was a weak and imperfect vessel for the soul, and therefore allowed to be subjected to scientific inquiry. Engel (1977) suggests this early encouragement of dualism (separation of body and mind) may have propelled Western medicine into a purely anatomically driven science. However, many physicians at the time recognized the importance of emotions in understanding the development and course of disease.
During the 1960s, the anti-psychiatry movement started to gain traction. Thomas Szasz (2001) argued that mental illness was a myth because it fell outside of the biomedical model of disease â no psychiatric disorder met the scientific definition of âdiseaseâ because it could not be recognized by a pathologist. Further, Szasz argued that a psychiatric diagnosis was used by members of the profession to solidify and bolster their social status, rather than to help the patient (Berlim, Fleck & Shorter, 2003; Wurtzburg & Thomson, 2014). At the time, psychiatry became under-siege by both the public and its practitioners. Two types of critics emerged â the reductionist, who argued that disease was completely explainable by biological underpinnings, and the exclusionist, who believed that whatever cannot be explained should be excluded from the category of disease.
Shortly before these times, and not receiving much attention, Roy Grinker first introduced the biopsychosocial view in his 1954 lecture and later argued for a unified model to understand human behavior and mental illness in his book, Toward a Unified Theory of Human Behavior (Grinker, 1956). However, Grinker was to go unrecognized as the founder of the biopsychosocial model, and much credit has been awarded to George Engel. Engel was an intern physician who published a paper challenging the biomedical model of disease for its reductionist view of mental illness, calling for a more person-centered and integrative scientific approach. Engelâs (1977) central argument of disagreement in the biomedical model was that it relied solely on somatic causes to disease, and discredited the value of psychological and social factors. Ignoring such important contributors of disease, Engel considered the biomedical model as dogma rather than a model (Benning, 2015). Instead, Engel (1977) made a simple conclusion, drawing from his observation as an intern physician, that biological, psychological, and social factors were interrelated in both the progression of disease and treatment outcome. George Engel (1981, p. 114) provided an example of the application of the...
