The Mark of Cain

Psychoanalytic Insight and the Psychopath

J. Reid Meloy

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781134902378
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

The Mark of Cain makes available for the first time the accumulated psychoanalytic understanding of the psychopathic mind. Editor Reid Meloy, a leading authority on the psychology of the psychopath, has brought together in a single collection the most historically important psychoanalytic papers on the psychopath and delineted their continuing relevance to contemporary understanding.

According to Meloy, two theoretical traditions flow into the psychoanalytic understanding of psychopathy. The first tributary focuses on the early development of the psychopath in order to illuminate how a profound alteration in self-regard leads both to a denigration of the other and to an impulsive search for gratification in the present. The second tributary seeks to locate the psychopathic miscarriage of human potentiality within analytic theories of personality structure and clinically grounded differential diagnosis. Meloy presents the major contributions associated with both of these traditions. Included within this body of literature are the original formulations of concepts that have long since become part of the psychoanalytic nomenclature: the "affectionless" juvenile offender, the diagnostic significance of "affect hunger," the behavioral consequences of "superego lacunae," the recourse to promiscuous identification in "the impostor," and the paradoxically lethal lure of "malignant narcissism." Of special interest are Meloy's historical notes to each chapter and two section introductions, the latter major essays in their own right.

The explosion of empirical research on psychopathy over the past two decades masks the fact that much contemporary work in this area is grounded in the clinical formulations of leading psychoanalysts of the twentieth century. The Mark of Cain rescues this intimate understanding of the inner world of the psychopath and thereby contributes to clinical realism in the face of deception, manipulation, exploitation, and even frank dangerousness.

Section I

Development and Psychodynamics

1

Introduction to Section I

J. Reid Meloy

Are psychopaths born or made? Robert Hare (personal communication, January 2000) told me this question was akin to attempting to describe a soccer field by its length or its width; both dimensions are necessary to capture the expanse, or expansive personality, that we see before us. When this question is posed to me by others, I point out that the more realistically based question is how nature and nurture shape each other over time, since a child comes into the world with a certain genotype that is phenotypically expressed according to the vagaries of personal experience.

ATTACHMENT, AROUSAL, AND ANXIETY

“The house of psychopath” is built on a psychobiological foundation of no attachment, underarousal, and minimal anxiety. I think these are necessary and related, but insufficient, characteristics that provide certain predispositions for the development of a psychopathic character.

Attachment is a biologically rooted, species-specific behavioral system that maintains close proximity between child and caretaker. It was first conceptualized and investigated by John Bowlby, James Robertson, and Mary Ainsworth at the Tavistock Clinic in London (Robertson and Bowlby, 1952; Bowlby, 1953; Ainsworth and Bowlby, 1954). Attachment is deeply rooted in both birds and mammals but is generally absent in reptiles.¹ It begins with goal-directed but objectless behaviors, such as sucking or crying, which seek to maintain physiological homeostasis in the human infant by securing warmth, touch, and food. Over time—the length of which is one of the contentious debates in developmental psychology—the proximity-seeking behavior becomes more object related and emotionally nuanced as the child attaches to the maternal object. Attachment is often defined as a strong affectional bond in both children and adults. Ainsworth (1989) termed it “a relatively long-enduring tie in which the partner is important as a unique individual and is interchangeable with none other” (p. 711). One of the reasons that attachment has been so thoroughly researched is the ease with which it can be behaviorally measured: proximity seeking to an object, distress when the object leaves, and the nature of the reunion behavior when the object returns. According to Miller (chapter 10, this volume) and Bursten (chapter 17, this volume), mastering mother’s return may be the central task of consolidating one’s healthy narcissism. A pathology of attachment is an acute or chronic disturbance in the bond that exists between infant and caretaker. Ainsworth (1989) labeled one of these disturbed patterns of attachment behavior anxious avoidant attachment and described it as a child’s attempting to live in a pseudo-autonomous manner, chronically displaying a pattern of detachment, or indifference, to the rejecting or intrusive, but also abandoning, object. The anxious avoidant child, however, is chronically stressed but still attached. Ainsworth paralleled this finding with the third stage of attachment disruption proper, detachment; but subsequent research indicated that detachment is a different pattern characterized by apathy, self-absorption, preoccupation with nonhuman objects, and no displays of emotion (Bowlby, 1969). After prolonged separation, or a series of attachment disruptions, this attachment pathology may usher in affectionless psychopathy, well illustrated by Bowlby’s 1944 paper on “Forty-Four Juvenile Thieves” (chapter 3, this volume). Bowlby (1988) later theorized that the attachment pattern seen in juvenile thieves is caused by constant maternal rejection. Current clinical wisdom supposes that future psychopaths are recruited chiefly from either the avoidant or the detached types.

Bartholomew (1990) developed a corresponding model of adult attachment based on positive and negative concepts of self and other. Her first three types—secure, preoccupied, and fearful—propose a certain positive and negative valence for the self and object; but most salient to psychopathy is her fourth type, dismissing attachment, which is analogous in some ways to the avoidant pattern of infancy.² Here is an easily understood pathology of attachment in which the self is viewed as positive and objects are viewed as negative. In a more psychodynamic frame, a narcissistic homeostasis is maintained through the idealization of the self and the devaluation of others. The dismissing attachment pattern relies on a strategy that minimizes distressing thoughts and affects associated with rejection by maintaining emotional distance from others (Rosenstein and Horowitz, 1996). Research has shown that dismissing attachment is correlated with conduct disorder and antisocial personality disorder (Allen, Hauser, and Borman-Spurrell, 1996), where it is assumed that acting-out behaviors are aimed at alleviating internal distress. In two related studies, Raine, Brennan, and Mednick (1994, 1997) demonstrated in a large cohort of Danish adult males that birth complications and maternal rejection in the first year of life predisposed them to an early onset (before 18 years) of violent crime (robbery, rape, murder, assault, or domestic violence). Having been reared in a public-care institution and a documented attempt to abort the fetus were among the data measuring their rejection by mother and obviously underscore the severity of the attachment disruption for these men.

The second corner of this psychobiological foundation is an arousal problem: autonomic hyporeactivity, especially to punishment or aversive consequences. The evidence for this variable extends back to the early work of Hare and his colleagues (Hare, 1970), which demonstrated peripheral autonomic irregularities among psychopaths, most notably through the use of skin conductance (SC) or GSR measures.³ Although his work focused on adult Canadian criminals, the finding of autonomic hyporeactivity to punishment has since been replicated in other samples, including noncriminals, by other independent research groups throughout the world (Raine, 1993). What appears to be implicated in these studies is an attentional deficit among antisocial and criminal populations, which is further validated by the power of attention deficit disorder in childhood to predict criminality (Gittelman et al., 1985; Weiss et al., 1985).

The research, however, is not without its inconsistencies. For instance, one area of study argues for the importance of schizotypy, or schizotypal personality disorder (DSM-IV: American Psychiatric Association, 1994), as a moderator variable for orienting deficits across samples of criminal, antisocial, and psychopathic individuals: high schizotypy in these groups increases their orienting deficits (Raine et al., 1999). Other research has shown enhanced orientation to a task among antisocials when it is seen as positive and interesting (Raine, 1989), while the orienting deficits appear limited to neutral or unpleasant stimuli.

The most important body of work related to arousal, however, and one that implicates the relationship between arousal, attachment problems, and violent criminality, is the biosocial research that finds “chronic cortical underarousal” to be a cause of early onset, and serious, habitual criminality (Raine et al., 1997). Not only do measures of chronic cortical underarousal, suggested by low resting heart rate, poor skin conductance, and slow wave (theta) EEG activity, correlate with habitual criminality, but together they have a predictive power that can override the influence of the environment, especially when the latter is what we would consider normal, nurturing, and “good enough.”

Raine, Venables, and Williams (1990) demonstrated that these three measures of low CNS and ANS arousal at age 15 in a nonrandom sample of London male adolescents predicted habitual criminality when the men reached age 24. In a test of a reversal of their hypothesis—that elevated levels of CNS and ANS reactivity would protect individuals who were raised by criminal fathers from habitual criminal behavior—Brennan et al. (1997) studied four samples of Danish males and did find significantly higher reactivity among the noncriminals raised by criminal fathers: even higher than the reactivity of the noncriminals raised by noncriminal fathers!

Extending their work on the relationship between cortical underarousal and aggression, Raine and his colleagues have published several studies of a large sample of Mauritian⁴ children (N = 1795) who are being followed longitudinally and were first examined at age three. The researchers’ first published study tested the hypothesis that low resting heart rate, the best replicated biological correlate of childhood antisocial and aggressive behavior (Raine, 1993), measured at three years of age, would predict aggression at age 11 years. They supported their hypothesis, and gender and ethnicity made no difference. Eleven different biological, psychological, and psychiatric mediators and confounds also did not change the significant group differences (Raine, Venables, and Mednick, 1997). In their second study, the same large sample of Indian and Creole children from Mauritius were tested in a prospective longitudinal design, and aggressive children at age 11 were found to have had increased measures of stimulation-seeking, fearlessness, height, and weight at age three years when compared with the nonaggressive children (Raine, Reynolds, et al., 1998). In their third study of the same children from Mauritius, a developing tropical country very different from our Western culture, Scarpa et al. (1997) showed that children designated inhibited at age three showed significantly higher heart rates and skin conductance arousal when compared with uninhibited children. Studies have shown that such inhibition is related to the development of future anxiety disorders (Kagan, Reznick, and Snidman, 1987; 1988), and reduced inhibition is related to future antisocial behavior (Farrington, 1987).

Which brings me to the third corner of this psychobiological foundation: minimal anxiety. When anxiety is felt, such inchoate unpleasant emotion may signal danger from within or from outside, and, when it is specifically object related, we refer to it as fear. When the object is fantasy based, or patently unreasonable, we may see the patient as phobic or delusional. Fear and anxiety appear to have distinct physiological substrates (Dien, 1999; Rosen and Schulkin, 1998).

From a developmental attachment perspective, interpersonal anxiety emerges, typically in the service of safety and survival when a child perceives a stranger, since distress in the infant in the presence of someone who is unknown may be a signal to the caretaker that real danger may exist. Bowlby (1960) noted that the evolutionary basis of the causes of anxiety—the appearance of a stranger, actual separation, the anticipation of loss—keeps the maternal object in close proximity to the child and the child out of the grasp of predators; society still punishes parents as “grossly negligent” who drift out of range of their infants’ distress calls, as if predators, in their contemporary metamorphosis as abductors⁵ and child molesters, lurk around every corner and in every park.

In the realm of antisocial behavior, particularly psychopathy, however, anxiety is minimal or absent. This conclusion was first noted in Lykken’s (1957) study, which found that anxiety differentiated secondary (anxious) psychopaths from primary (nonanxious) psychopaths. Blackburn (1975, 1998) has also identified these secondary psychopaths as being socially anxious, withdrawn, and moody, in contrast to primary psychopaths, who are hostile, extraverted, self-confident, and low-to-average anxious. Other laboratory studies support the clinical observation that anxiety is low in psychopaths (Ogloff and Wong, 1990), but self-report measures typically show a weak or neutral relationship between psychopathy and anxiety (Hare, 1991). Negative correlations between anxiety and psychopathy are more evident if the “aggressive narcissism” (Meloy, 1992) aspect of psychopathy is factored in. This component appears in children at risk of becoming psychopaths in adulthood and is referred to as a “callous / unemotional” factor or grouping of traits (Frick et al., 1994).

There is, however, a problem. Rates of anxiety disorders in conduct-disordered children range from 22% to 33% in community samples (Russo and Beidel, 1993), and significant correlations are found between antisocial behavior and anxiety on various childhood behavioral rating scales. Even the diagnosis of antisocial personality disorder in adulthood (DSM-IV: American Psychiatric Association, 1994) highly correlates with a variety of Axis I anxiety disorders (Boyd et al., 1984). How do we reconcile these findings with the low-anxiety hypothesis as a foundation for psychopathy? The answer appears to lie in separating the callous / unemotional traits of the psychopathic child from his impulsivity / conduct problems. When this is done (Frick et al., 1999), there emerges a strong negative relationship between these traits and anxiety in the psychopathic child: as subjects become more callous and unemotional, their anxiety dissipates. And, if the presence of conduct problems is controlled, a significant positive correlation between fearlessness and callous / unemotionality is seen. In other words, when the internal life of the child at risk for psychopathy, or what Lynam (1996) refers to as the “fledgling psychopath,” is carefully studied and his acting-out behaviors are viewed as secondary to his emotional and defensive construction, a clear picture emerges of a developing youngster who has minimal anxiety and is essentially fearless.

No attachment, underarousal, and minimal anxiety biologically anchor the foundation of the psychopath. As we see later in adulthood, these substrates manifest in a fearless and sensation-seeking lifestyle, one that is unfettered by the constraints of an affectional bond, excitability or worry, or fear of violating the rules of others.

David Levy (chapter 2, this volume), John Bowlby (chapter 3), Lauretta Bender (chapter 5), and Kate Friedlander (chapter 6) are the early pioneers who charted the unknown territory of attachment pathology in psychopathy. Although they did not have knowledge of the inherited and acquired biological defects that provide the foundation for the “house of psychopath,” their insights into the phenomenology of these patterns—and their thoughtful speculation as to etiology—are quite remarkable. For example, most of our earliest authors focus on the impact of neglect in fostering anger, impeding the formation of an object relation to the mother, and stimulating a pseudo-autonomous striving that we label pathologically narcissistic. They also stress the centrality of the joy of loving, and the pleasure derived from it, for both mother and child. Perhaps most important, the beginnings of character disturbance may be concealed by a surface adaptation, what Cleckley (1941) would later call a “mask of sanity.”

FAILURES OF INTERNALIZATION

Psychological failures parallel the biological deficits of the “fledgling psychopath” (Lynam, 1996). These are failures of internalization, which Hartmann (1939) originally described as the evolutionary and phylogenetic transfer of functional-regulatory mechanisms from outside to inside. Piaget (1954) called this process assimilation, and Schafer (1968) noted that this transfer can be either reality based or fantasy based.

Within traditional psychoanalytic theory, failures of internalization begin with an organismic distrust of the sensory-perceptual environment and selective early incorporative deficits. Incorporation is the most developmentally primitive form of internalization, as the infant attempts to take in an object through the mouth; and, depending on the nature of the object—whether hard or soft—the consequent behavior will be to suck or to bite, to swallow or to sever. If normal development proceeds, these incorporative experiences are mostly hedonic, psychologically gratifying, and physiologically stabilizing. The emotional background of these incorporative experiences is a basic trust of the holding environment (Erikson, 1950).

In psychopathy, however, these incorporative failures⁶ predict subsequent problems with two kinds of internalization: identifications and introjections. Identifications are modifications of the self or behavior to increase resemblance to the object (Schafer, 1968). Introjections are objects that are internalized but maintain a relationship to the self. When an introjection is conscious, it may be “seen” or “heard” in the mind, but it is not considered part of the self. It is subjectively experienced as “not-I” (Meloy, 1985). Borderline personality-disordered patients often complain of such powerful persecutory “voices,” and these introjects may be misdiagnosed as auditory hallucinations.

In psychopathy, objects desired for internalization as either identifications or introjects are completely absent, not available when wanted, or harsh and unpleasant. There results a dearth of soothing internalization experiences. Through various kinds of conditioning, such as punishment (the presentation of an unpleasant stimulus) or negative reinforcement (the withdrawal of a pleasant stimulus), the child may come to anticipate hard, aggressive objects and may identify with such objects for both adaptive and defensive reasons.

Grotstein (1982) referred to an associated identification as the stranger selfobject and defined it as a normal preconceived fantasy that helps the infant anticipate the presence of the predator in the external world. I refer to this fantasy in the fledgling psychopath as the predator part-obj...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Dedication
• Contents
• Preface
• Acknowledgments
• Section I. Development and Psychodynamics
• Section II. Treatment, Risk Management, and Psychodiagnosis
• Index