Professional Psychology: Research and Practice
2006, Vol. 37, No. 1, 59 – 65
Copyright 2006 by the American Psychological Association
0735-7028/06/$12.00 DOI: 10.1037/0735-7028.37.1.59
Unresolved Controversies Concerning Psychopathy: Implications for
Clinical and Forensic Decision Making
John F. Edens
Southern Methodist University
At some point in their careers, clinicians who work or consult in forensic and correctional settings will
almost certainly encounter individuals who exhibit psychopathic personality features. Because of the
widespread use of this disorder to inform legal and clinical decision making, psychologists should be
exceedingly familiar with the relevant research literature on this topic before venturing into these settings.
This article reviews the empirical bases of several clinically relevant claims and assertions regarding
psychopathy and concludes that many areas of research are decidedly more equivocal in their findings
than is commonly perceived. Although there is much to be gained by assessing psychopathy in various
contexts, clinicians need to be cautious about drawing overzealous and empirically questionable conclusions about an important disorder that also has great potential for abuse.
Keywords: psychopathy, PCL-R, forensic, controversies, decision making
assessment instruments, and professional guidelines. As such, familiarity with the ever-burgeoning psychopathy literature would
seem to be a prerequisite to engaging in many types of forensic
assessments or providing therapeutic services in correctional
settings.
Because of the ever-increasing use of psychopathy assessments
to inform life-altering (e.g., indeterminate confinement) or even
life-ending (e.g., capital punishment) legal decisions around the
world (Cunningham & Reidy, 2002; Edens & Petrila, 2006), one
could argue that the bar is higher in terms of the need for clinicians
to avoid erroneous or at least highly controversial conclusions
about those identified as “psychopathic.” In addition, because of
the highly prejudicial associations that the label psychopath evokes
among the lay public (e.g., Ted Bundy, Charles Manson; see
Helfgott, 1997; see also Edens, Colwell, Desforges, & Fernandez,
2005), practitioners should be clear about what such a label does
and does not imply about adults and children who display personality features that appear to be consistent with historical conceptions of this disorder.
Given the ramifications of the psychopathy label, the purpose of
the current review is to address several contentious issues regarding this disorder that are directly relevant to its use in legal and
clinical decision making. The particular topics reviewed reflect
areas in which I have observed clinicians and researchers drawing
overly forceful, categorical, or sweeping conclusions about psychopathy in the courtroom, in formal and informal talks, and/or in
print.1 I believe that close inspection of the available research
evidence indicates that considerable restraint is warranted in relation to these topics. In the sections below, I describe several
Few disorders would seem to elicit as visceral a reaction among
mental health professionals as psychopathic personality (psychopathy). Almost by definition, highly psychopathic individuals are
those who use deception, subterfuge, coercion, and perhaps even
outright violence to accomplish their goals, with a callous disregard for the potentially devastated lives they leave in their wake
(Hare, 1993, 1996). Informal discussions with clinicians and anecdotal accounts in the published literature suggest that mental
health professionals are by no means immune to such manipulation
in that they frequently are duped or conned in both their clinical
and forensic work (Cleckley, 1976; Hare, 1993, 1998). Because
many clinicians appear to be increasingly augmenting their practices by providing services in forensic or correctional settings
(Otto & Heilbrun, 2002), it appears likely that greater involvement
with the criminal justice system will lead to increased contact with
highly psychopathic clients or examinees, who typically account
for 20% to 30% of prison populations (Hare, 2003). Because good
clinical practice is founded on appropriate knowledge, skills, and
experience, it seems ethically mandated that those who work in
such settings should be familiar with relevant empirical literature,
JOHN F. EDENS received his PhD in clinical psychology from Texas
A&M University in 1996. He is currently an associate professor in
the Department of Psychology at Southern Methodist University.
His clinical and research interests focus on forensic assessment
and the use of psychological data to inform legal decision making.
He frequently serves as a consultant on criminal cases involving
mental health evidence. In 2001, he was the corecipient of the
Saleem Shah Award for Early Career Contributions to Law and
Psychology, awarded by the American Psychology-Law Society
and the American Academy of Forensic Psychology.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to
John F. Edens, Department of Psychology, Southern Methodist
University, P.O. Box 750442, Dallas, TX 75275-0442. E-mail:
jedens@smu.edu
1
Which is not to suggest that the present review constitutes an exhaustive list of controversies by any means. For example, the use of the
Rorschach to assess psychopathy has come under extensive criticism (e.g.,
Wood, Lilienfeld, Garb, & Nezworski, 2000) and the construct validity and
utility of self-report measures of psychopathy continues to be a widely
debated topic (e.g., Lilienfeld & Fowler, 2006).
59
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60
conclusions about psychopathy that appear difficult to defend
empirically, I briefly summarize evidence bearing on these issues,
and I highlight some of the practice implications of what I argue to
be more qualified but defensible interpretations of the current
literature. By highlighting some of the current limitations of what
is known about psychopathy, I hope that practitioners can avoid
possible abuses of what Hare (1998) described as “the single most
important clinical construct in the criminal justice system” (p. 99).
“Once a Psychopath, Always a Psychopath”
The Controversy
The position that psychopathy is remarkably stable over time
underlies much that has been written about this disorder in that it
is argued essentially to reflect a dispositional, immutable personality constellation (e.g., Gacono, 2000). One version of the “immutable personality” assertion applies to the developmental trajectory of children. Unlike Athena, highly psychopathic adults do
not spring forth fully formed from the head of Zeus—this is clear.
Existing evidence suggests that adults who obtain high scores on
the most widely studied measure of psychopathy, the Psychopathy
Checklist–Revised (PCL-R; Hare, 2003), start showing some signs
of the characteristic traits and behaviors at a relatively early age. In
fact, the scoring of some PCL-R items is based specifically on such
conduct. It cannot be stated emphatically enough that these findings do not lead to the inevitable conclusion that the presence of
psychopathic-looking “traits” among children and adolescents will
ultimately result in adults who continue to demonstrate these traits
and behaviors (Edens, Skeem, Cruise, & Cauffman, 2001; Hart,
Watt, & Vincent, 2002).2 The field lacks any significant longitudinal research regarding the stability of these traits, although the
available evidence suggests that more extreme scores identified
among young children in particular may regress toward the mean
in many instances (e.g., Frick, Kimonis, Dandreaux, & Farell,
2003; see also Cauffman & Skeem, 2004).
The second version of the immutability argument relates to
adults. Cross-sectional studies clearly indicate that there are older
individuals in prison settings who exhibit psychopathic traits to a
considerable degree, although as a group these older individuals
display somewhat lower scores on the factor of the PCL-R (Factor
2) more strongly wedded to impulsivity, social deviance, and
violence (Hare, 2003). The available research by definition comes
from offenders who are in prison settings—perhaps specifically
because they have committed serious criminal acts relatively late
in life. There are no well-controlled longitudinal studies that have
followed young, highly psychopathic adults to determine whether
they in fact are very likely to end up as highly psychopathic adults
much later in life. The closest approximation to such a study was
conducted by Rutherford, Cacciola, Alterman, McKay, and Cooke
(1999) with 200 male and 25 female methaodone patients over a
2-year follow-up. Intraclass correlations for dichotomous classifications and continuous PCL-R scores ranged from .48 to .67.
Although generally supportive of a relative degree of stability at
the group level, such results offer little support for arguments
regarding the immutability of psychopathy.
Practice Implications
Certainly the early onset of severe callousness, egocentricity,
and other characteristics or behaviors similar to adult psychopathy
should not be ignored or dismissed. Neither should they be asserted to portend an ominous downward spiral that will inevitably
lead to adult psychopathy, particularly given the developmental
fluidity of childhood and adolescent characteristics such as grandiosity, impulsivity, and irresponsibility (Edens, Skeem, et al.,
2001; Frick et al., 2003). In settings in which the presumed
stability of a “bad character” may have profound weight in terms
of subsequent treatment and rehabilitation efforts (e.g., waiving
adolescent offenders out of the juvenile and into the adult criminal
justice system), mental health examiners should be forthcoming
about how little is actually known about the stability of these
characteristics among children and adolescents. In relation to
adults, examiners would do well to avoid longitudinal claims about
the constancy of a particular individual’s psychopathic traits when
these claims are based on cross-sectional studies of PCL-R scores
across highly select samples of prison inmates and forensic patients (see the “Psychopaths Cannot Be Treated” section below as
well).
“Where the Psychopath Goes, Violence Will Surely
Follow”
The Controversy
One could argue that the extensive attention given to psychopathy over the last few decades has been largely attributable to its
association with violence. In fact, some commentators have even
described the PCL-R as the “unparalleled” measure of violence
risk (Salekin, Rogers, & Sewell, 1996; cf. Gendreau, Goggin, &
Smith, 2002; Walters, 2003)—a position that also has been frequently endorsed in court cases (e.g., R. v. K.S., 2004; R. v. LaRue,
2003). In many contexts, clinicians should be encouraged to consider the presence of psychopathic traits when attempting to assess
the likelihood that someone may act out aggressively, particularly
when one considers the recurrent finding that clinicians routinely
focus on violence-risk factors that have little or no empirical
support (e.g., Elbogen, Mercado, Scalora, & Tomkins, 2002).
Although it would be defensible, in the aggregate, to conclude
that elevated PCL-R scores identify individuals who may be more
violence-prone, the problem with such assertions in individual
cases is that examinees are never in aggregate contexts. Although
several meta-analyses (e.g., Gendreau et al., 2002; Walters, 2003)
and other large-scale studies have demonstrated that psychopathy
typically is associated with higher rates of violent and other forms
of criminal conduct in the community, such probabilistic findings
obviously do not support absolutistic assertions made by some
examiners that individuals who are psychopathic will necessarily
engage in violent conduct in the future. More important, the
“average” association between psychopathy and violence in these
meta-analyses belies the fact that across studies the strength of this
relationship is remarkably heterogeneous. The implication here is
that one should not discuss the “global” relationship between
psychopathy and violence but, instead, should consider other factors (e.g., context) that might help practitioners and researchers
2
When confronted with this logical fallacy (affirming the consequent),
a useful strategy is to ask whether because all adult psychopathic offenders
ate baby food as infants, eating baby food would be expected to be a good
predictor of adult psychopathy.
CONTROVERSIES CONCERNING PSYCHOPATHY
better understand why such variability exists across different populations and settings.
As an example of the importance of context in risk assessment,
it is worth noting that highly psychopathic individuals often end up
in environments specifically designed to inhibit violence (e.g.,
maximum-security prisons), which of course may reduce the number of opportunities to act out. Even when acting out does occur,
however, there is growing evidence that psychopathy may not be
a particularly useful risk factor in U.S. prison systems. For example, Guy, Edens, Anthony, and Douglas (2005) recently reported
mean meta-analytic correlations between the PCL measures and
prison violence that were considerably weaker in studies of U.S.
prisoners (rw ⫽ .10) than in studies of non-U.S. prisoners (rw ⫽
.24).3
Another issue of contention in relation to the “psychopathy
equals violence” argument relates to assertions that psychopathic
individuals are highly prone to serious aggression even beyond the
age when most criminals tend to “burn out.” This is an issue that
arises in death penalty cases in which an offender might be
released after serving a 30-year sentence in some jurisdictions
(Cunningham & Reidy, 2002; Edens, Petrila, & BuffingtonVollum, 2001). Support for this position perhaps stems most
directly from an early study by Hare, Forth, and Strachan (1992),
in which they concluded that “the psychopath’s propensity for
violence and aggression may be relatively persistent across much
of the life span” (p. 295). One other small study (Harris, Rice, &
Cormier, 1991) reported that psychopathic inmates over the age of
40 were more likely to reoffend violently than were comparably
aged nonpsychopathic offenders. Despite these early findings, one
large-scale subsequent study has failed to replicate these results
(Porter, Birt, & Boer, 2001 [see Figure 1, p. 654; also see Figure 2,
p. 655]), and a reanalysis of the Hare et al. (1992) results also
strongly contradicted the “persistent-violence” assertion (Edens,
Petrila, & Buffington-Vollum, 2001).4
Practice Implications
The fact that the magnitude of the psychopathy–violence association has varied widely from study to study would seem to
compel examiners to be very specific about exactly what types of
settings and circumstances are being considered when making
statements about risk for future violence. For example, in relation
to U.S. prisons, it would seem hard to defend using the PCL-R in
an attempt to identify inmates who are likely to be violent given
the modest relationship noted in the literature. Even if statistically
significant because of large sample sizes, a correlation of .10 (Guy
et al., 2005) indicates that a large number of false positives will
occur if the PCL-R is used to sort individuals into higher versus
lower risk groups.
Additionally, at present there is no evidence to suggest that
practitioners should be using psychopathy scores to make predictions regarding the likelihood of violent behavior literally decades
later. Even if a highly psychopathic 50-year-old prison inmate
were at increased risk for violence if released into the community,
that does not imply that a highly psychopathic 20-year-old inmate
will continue to be at increased risk for violence if released at the
age of 50. The relevance of including the PCL-R when assessing
recidivism risk for an older offender seems questionable at best at
present, and assessing risk in a 20-year-old to ascertain whether he
61
or she may be violent 30 years later is clearly guesswork that
presently lacks any scientific foundation.
When using the PCL-R, it would be helpful if examiners provided descriptive information to the consumers of their evaluations
regarding exactly how useful particular correlational results are in
relation to the specific contexts and samples under consideration.
For example, in a large sample of British prison inmates, Hare,
Clark, Grann, and Thornton (2000) reported that 42% of those with
elevated PCL-R scores committed an assault in prison, whereas
only 16.4% of those with lower scores engaged in such institutional misconduct. Similarly, Edens, Buffington-Vollum, Keilen,
Roskamp, and Anthony (2005) recently noted that across three
U.S. prison samples in which the base rate of violent infractions
was 22.2% for the entire group (N ⫽ 293), only 25% of the
psychopathic offenders committed such an infraction. Descriptive
values such as these arguably are much more informative for
laypersons than are the more complex summary statistics (e.g.,
receiver operating characteristic curves, biserial correlations) typically reported in most research studies. Unfortunately, descriptive
statistics often are not provided in these studies.
A final point to note is that even if an examiner deems psychopathy relevant to include in a risk assessment, it seems untenable that someone would ever rely solely on the PCL-R, because
there are certainly instances in which low scores cannot be equated
with low risk (see Hare, 1998, for examples) and other circumstances where high scorers can be managed successfully without
major incident (Cooke, 1997; Hare et al., 2000). Practitioners may
well need to consider the relevance of psychopathy when asked to
make inferences about risk for violence and criminality, but they
should never base their opinions exclusively on PCL-R measures
when conducting such work (Hemphill & Hare, 2004). For a useful
example of how the PCL-R may be incorporated with other risk
factors, interested readers should examine the HCR–20 (Webster,
Douglas, Eaves, & Hart, 1997).
“Psychopaths Cannot Be Treated”
The Controversy
This position has been espoused with varying degrees of certainty by mental health experts and judges in criminal proceedings
(e.g., Barefoot v. Estelle, 1983; U.S. v. Stitt, 1998) and in published
research reviews (e.g., Gacono, Nieberding, Owen, Rubel, & Bod3
These meta-analytic findings stand in sharp contrast to some of the
opinions offered by prosecution experts in capital trials. Although not
based on the PCL-R per se, testimony in the now infamous Barefoot v.
Estelle (1983) case represents perhaps the most extreme form of overreaching that has been documented. In response to a description of a hypothetical
offender with a criminal history similar to the defendant, James Grigson
asserted that such a person would be a sociopath of the “most severe
category” (p. 919) and that there was a “one hundred percent and absolute”
(p. 919) chance that he would commit future acts of violence— even if in
prison. As empirically unsupportable as this conclusion was (Cunningham
& Reidy, 2002), the U.S. Supreme Court’s affirmative decision gave
experts considerable latitude to opine with great certainty about violence
risk posed by criminal defendants, a precedent that still holds today.
4
Edens, Petrila, and Buffington-Vollum (2001) reported that in the
combined 41–50-year-old age range, the rates of violent reoffending were
11.6% for the psychopathic and 7.4% for the nonpsychopathic groups (ns).
EDENS
62
holdt, 1997). Gacono et al. (1997), in fact, argued that there was
“nothing the behavioral sciences can offer for treating those with
psychopathy” (p. 119). This conclusion seems to have taken hold
in some arenas in that high PCL-R scores increasingly serve as the
rationale for denying treatment services to some offenders
(D’Silva, Duggan, & McCarthy, 2004). The “cannot-be-treated”
argument is driven mostly by a consideration of research suggesting that adults and adolescents with elevated scores on the PCL-R
measures are less likely to respond to the types of interventions
that have been investigated in the past (e.g., Hare et al., 2000).
Although it would be hard to argue that psychopathy does not
raise serious concerns about treatment responsiveness, the certitude of negative outcomes has been challenged by recent reviews
(D’Silva et al., 2004) and research findings (Cooke, 1997; Skeem,
Monahan, & Mulvey, 2002). Most of the earlier outcome studies
with psychopathic offenders were methodologically weak, and
none appear to have been based on rehabilitation principles that
have shown some degree of efficacy among criminals (see Dowden & Andrews, 2000, for a meta-analytic review of the offendertreatment literature). Additionally, one widely cited program involved “novel” interventions that would be considered unethical
by today’s standards (see Harris, Rice, & Cormier, 1994, for an
extensive review of a program that involved, among other “treatments,” marathon nude encounter groups).
Practice Implications
Therapeutic nihilism, although perhaps understandable given
the affective and interpersonal traits associated with psychopathy,
would seem to be somewhat premature in relation to the treatment
and management of psychopathic individuals. Moreover, promising alternative intervention strategies (e.g., Wong & Hare, in
press) have yet to be investigated in any systematic fashion. It may
very well be that psychopathic offenders ultimately will need some
type of intervention that is fundamentally different from what has
been demonstrated to be effective with inmates in general. At
present, however, it is not even known whether effective rehabilitation methods will have some impact with this subgroup of
offenders, because such programs have yet to be studied.
Regarding clinical opinions about treatment responsiveness, in
relation to adult offenders it would seem defensible for examiners
to assert that there is no known intervention that has been shown
to be particularly effective with individuals high in psychopathic
traits, although there appears to be some evidence that psychiatric
patients high in psychopathic traits who can be engaged in treatment may respond in a positive fashion (Skeem et al., 2002).
Practitioners also should be aware, however, that therapist impressions of “positive treatment outcome” should not be assumed to
reflect actual positive treatment outcome—at least one study of sex
offenders found that psychopathic individuals who were presumed
to have benefited from treatment were at heightened risk for
criminal recidivism (Seto & Barbaree, 1999).5
“Clinical Evaluations of Psychopathy Are Highly
Reliable”
The Controversy
This position, which is a quite reasonable summary of published
research studies, is a potential source of confusion in applied
settings where individual PCL-R ratings are being considered.
Results summarized in the most recent PCL-R manual (Hare,
2003) clearly suggest that well-trained examiners can score the
PCL-R and its derivatives reliably, particularly when there is
considerable file information available to inform these ratings. The
standard error of measurement (SEM) for the PCL-R reported in
the new manual ranges from 2.7 to 3.4, depending on the sample
and the scoring method used.
Despite these encouraging findings, such results do not lead to
the inevitable conclusion that a particular PCL-R score is a close
approximation of any given offender’s “true” level of psychopathy— especially in highly adversarial settings. In fact, examples of
rather significant disagreements in the scoring of the PCL-R are
evident in several legal cases (see, e.g., R. v. K.S., 2004, in which
one examiner indicated that the defendant’s PCL-R score fell at the
32nd percentile, whereas the other argued it was at the 91st
percentile). Although there are several potential explanations for
such discrepancies (e.g., poorly trained examiners), one possibility
is that in some cases there simply may be inadequate information
upon which to make reliable ratings. Related to this latter issue, an
interesting and apparently unexplored area of clinical practice is at
what point examiners believe they have sufficient information to
score psychopathy scales (Edens & Petrila, 2006). The PCL-R
manual (Hare, 2003) is clear that it should not be used absent
sufficient file information, but it is not entirely clear on what
constitutes “sufficient” in any given case.
Practice Implications
Although there is no mandated level of training that individual
examiners should have prior to using the PCL-R or its derivatives
in applied settings (Hare, 2003), clearly it is not an instrument that
can simply be “bought and used.” The PCL-R manual provides
excellent guidance in terms of what sorts of background and
training experiences are needed prior to using this instrument, but
it is apparent that examiners have misused the PCL-R and made
ratings that were quite suspect in some cases (Edens, 2001; Hare,
1998).
One potentially useful modification of current practices would
be to report PCL-R scores with a confidence interval rather than as
simply a number (Edens & Petrila, 2006). Consistent with Hare’s
(2003, pp. 66 – 67) description of the expected range in which an
examinee’s “true” score is likely to fall, this procedure would help
the psychometrically unsophisticated understand that such assessment results are subject to a certain degree of imprecision or error,
even under the best of circumstances. For example, on the basis of
SEMs reported in the manual the 95% confidence interval for a
hypothetical PCL-R score of 25 for a male offender would be
approximately 19 –31.6 Aside from perhaps fostering a more realistic appraisal of the stability of psychopathy scores among laypersons who review such information (e.g., jurors), such score
ranges also might be helpful for countering criticisms when cross5
Despite this finding, which has been widely cited in the literature,
Barbaree (2005) recently published an extended follow-up study on this
sample that found that treatment behavior was unrelated to recidivism.
6
In a blatant distortion of the stability of a psychopathy score, I recently
observed an expert testify to a jury that his PCL-R rating of a defendant
CONTROVERSIES CONCERNING PSYCHOPATHY
63
examination suggests that a particular item score for an examinee
is questionable.
ation’s (2001) recommendations regarding the use of nonstigmatizing language (see also Forth, Kosson, & Hare, 2003).
“Psychopaths Are Qualitatively Different From Other
Offenders”
Concluding Remarks
The Controversy
It has been argued by some commentators that psychopaths
“comprise a discrete natural class of individuals” (Harris, Skilling,
& Rice, 2001, p. 197). This conclusion is driven in large part by a
widely cited article by Harris, Rice, and Quinsey (1994) in which
they claimed to identify a latent taxon on the PCL-R in a large
Canadian sample of forensic patients using complex statistical
procedures first developed by Paul Meehl and his colleagues.
Although perhaps an intuitively appealing position that helps to
psychologically distance the psychopathic offender from the rest
of society, blanket assertions that psychopaths are a “discrete
natural class” are much more questionable than would be gleaned
from the Harris et al. (2001) review. More recent taxometric
studies using both the PCL-R and other psychopathy measures
have been much more consistent with the argument that psychopaths differ from other offenders in degree rather than in kind
(Edens, Marcus, Lilienfeld, & Poythress, in press; Guay, Ruscio,
Hare, & Knight, 2004; Marcus, John, & Edens, 2004; cf. Skilling,
Quinsey, & Craig, 2001).
Practice Implications
At first glance, taxometric debates may seem to be something of
an ivory tower topic that is far removed from clinical practice—
particularly given that identifying a particular class of individuals
on the basis of even an arbitrarily defined score may be useful for
applied decision-making purposes (e.g., identifying an optimal
PCL-R score to differentiate more vs. less violence-prone offenders). Despite this, I believe there are clear real-world implications
regarding this controversy. For example, referring to an examinee
or client as “a psychopath” implies a dichotomous distinction
between those who “are” and those who “are not” psychopaths,
despite the markedly inconsistent findings in the available scientific studies on this topic. Moreover, many legal decision makers
already seem to have either implicitly or explicitly adopted this
categorical model, reflected in recurrent debates in court cases
regarding whether a particular defendant is “diagnosable” as a
psychopath (i.e., is 30 or above on the PCL-R). As noted earlier,
if examiners were to focus attention on confidence intervals rather
than on raw scores or categorical placements, perhaps decision
makers would be less preoccupied with the difference between a
score of 29 and a score of 30 on this instrument (Edens & Petrila,
2006).
Finally, even if psychopathy were ultimately found to be taxonic, from a semantic perspective, referring to individuals by their
disorder or diagnosis (e.g., “the schizophrenic,” “the retardate”)
only encourages others to define such persons by their pathology
rather than seeing them as an individual with such a condition.
Although referring to offenders with an elevated score on the
PCL-R as “highly psychopathic” or “high in psychopathic traits”
may seem less attractive to some, terminology such as “the psychopath” is inconsistent with the American Psychological Associ-
The PCL-R is a widely used and valuable instrument, but like
any assessment procedure, it can be misused or oversold in various
ways to support numerous objectives. In hindsight, the areas of
concern noted above would seem to reflect two general themes
related to potential overreaching on the part of mental health
experts that are not unique to psychopathy per se. The first is the
longstanding nomothetic-versus-idiographic problem of what
types of conclusions or predictions are appropriate to make about
individuals on the basis of group-level data. This problem is
evident in relation to making statements about the stability or
treatability of psychopathy as well as regarding the likelihood of
future violence. Categorical predictions (e.g., “This individual
will/will not be violent in the future”) based on psychopathy
ratings go well beyond what reasonably can be concluded on the
basis of the probabilistic nature of this relationship—and the
probabilistic relationship itself seems to vary widely from one
study to the next.
The second general theme is the effect of working in an adversarial criminal context, where there is a press to move from
objective “expert” neutrality toward asserting positions or opinions
that are most favorable to the side that has retained the clinician,
or at least asserting them in the most favorable way possible
(Shuman & Greenberg, 2003). As such, it is perhaps not entirely
surprising that examiners might be somewhat prone to draw conclusions or make assertions that overstate or perhaps misconstrue
what is currently known about this particularly troubling personality disorder. There is ample evidence that the objectivity of
mental health experts already is viewed with considerable skepticism in the legal system (e.g., Otto & Heilbrun, 2002), however,
and drawing definitive conclusions about topics that can easily be
demonstrated to be at least very controversial will only undermine
experts’ credibility and give further ammunition to those who
question whether mental health professionals should be involved
in the legal system (e.g., Hagen, 1997).
As a final point, I would suggest that some of what drives what
I perceive to be the overzealousness about psychopathy is the
desire of some professionals to bolster the relevance of clinical
psychology in forensic and correctional decision making, where its
contributions over the past few decades have been (somewhat
speciously, I would argue) devalued (see, generally, Andrews,
Bonta, & Hoge, 1990). A PCL-R score is not a simple actuarial
checklist that can be completed by a correctional technician with
minimal training. It reflects a complex psychological construct that
is not easily dismissed or explained by most sociological and
criminological models of crime and violence, which typically
minimize the role of individual differences. But the PCL-R is only
one tool in the armamentarium of the forensically proficient clinician (Otto & Heilbrun, 2002), who should be well versed in its
strengths and limitations. Ten years ago, Hare (1996) asserted that
psychopathy was “a clinical construct whose time has come” (p.
was highly reliable and that, if 100 other examiners readministered it, 90 of
them would give him the exact same score.
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64
25). Let us hope that in the next decade it does not become,
because of overly enthusiastic misapplication, a clinical construct
in need of restraint.
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Received September 30, 2004
Revision received June 14, 2005
Accepted July 1, 2005 䡲