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Mental Disorders

by Robert D. Hare, Ph.D.
Guilford Press, 1999
Review by Christian Perring, Ph.D. on Apr 25th 1999

Without ConscienceHere’s a book that shows why philosophers need to be studying psychiatry: the author, Robert Hare, takes a high moral tone but avoids the most difficult questions about psychopaths. Some think that if a person meets the conditions for one of the mental disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual, then that person is "crazy," "nuts," or "a lunatic." Hare takes the opposite view: he thinks that although psychopaths do qualify a psychiatric diagnosis, this does not mean that they are insane. Hare’s book, while interesting, is not sophisticated enough to justify its main moral claim.

The factual parts of Without Conscience are useful and interesting. The author’s professional life has revolved around psychopaths; his main work has been in diagnosis, and he explains that his Psychopathy Checklist is the best tool for discovering true psychopaths. With this list, one can predict with greater certainty which criminals are likely to reoffend if they are released from prison. Hare also believes that the category of Antisocial Personality Disorder (or Conduct Disorder for children) is overused, basically being applied to anyone who has criminal tendencies. He reserves the term psychopath to people who meet the much stricter set of criteria on his checklist.

The crucial issue is how to describe psychopaths. They are certainly self-centered and often act impulsively. They lie a great deal, and manipulate others for their personal gain. Sometimes they are violent. Often they do stupid things which lead to getting caught and often put in jail. Yet psychopaths are often charming and manipulative, which helps to explain how they regularly get early parole, and why they manage to dupe people in the first place. This leads us to the first of the central puzzles concerning this disorder: are psychopaths coldly calculating or do they rely on their instincts? The second main puzzle is how to describe their lack of conscience. What is clear is that psychopaths do not feel great sympathy for the people they hurt. But is this because they are morally bad, or alternatively is it because they have a personality or cognitive deficit? Or is this a false distinction? Can being evil simply be a matter of not being able to care for the plight of others?

This is the central question for much of Without Conscience. Mad or bad? Hare does at least do a good job of setting forth the problem, and manages to give a clear description of what it is to be a psychopath. He illustrates his chapters with many graphic examples, and uses many anecdotes and excerpts from newspaper stories to illustrate his claims. But it tends to also make the book read like a "true crime" story. Often I found that I was reading the book in the voice of the presenter of America’s Most Wanted, the sensationalist and self-righteous show on Fox TV. But when it comes to the crunch, Hare provides confusing information and refuses to take a stand. He is ready to say that psychopaths have something wrong with them, which is related to their lack of conscience. He also describes this as a lack of inhibition and self-control. But at the same time he says that psychopaths do not lose control, and are always aware of how they are behaving. Similarly confusing is the fact that he also describes psychopaths as having more freedom than other people: the choices of normal people are limited by their conscience, while psychopaths know no such limits. So on this description, it is normal people who have the deficit.

Hare does show an awareness of the difficult question: he writes that some people think that psychopaths are at a serious disadvantage because although they are intellectually aware that society has moral rules, they have no emotional understanding of morality. He briefly argues that this may make some theoretical sense, but should have no practical implications, because it is clear that psychopaths have enough understanding of morality to pass the legal test for insanity.

But of course this begs the very question at stake, which is whether the current legal test for insanity is adequate. Even if the test is adequate for legal purposes, it still leaves unresolved an important moral question that has implications for people’s lives, which is, should we blame a psychopath? Can or can’t we say about the psychopath, "he doesn’t know any better"? The answer seems to be both yes and no. Yes, in that the psychopath does not emotionally understand the rules of morality, even while he does intellectually understand them. When we talk of a person having freedom of action, it seems that there must be two senses in which we can mean this: first, intellectually understanding what options are open, and second, emotionally being able to bring oneself to actually act on those options. So now the question becomes, which kind of understanding and freedom is the relevant one when it comes to holding people responsible for their actions?

A question that Hare never even considers is why being a psychopath should count as having a psychiatric disorder in the first place. He shows clearly that there is no treatment we can rely on to change the personality of a psychopath, and he expresses great skepticism and only a little hope at the prospect that a successful treatment may be discovered in the future. Given what he says about psychopaths, it isn’t clear that the condition should count as a psychiatric disorder. There is of course clear evidence that psychopaths are different from other people, in their behavior, thought processes, and language. This may be linked to structural differences in the brain. However, being different does not mean that one has a disorder. Hare is certainly willing to hold psychopaths legally responsible for their behavior. This leaves it unclear what reason there is to classify being a psychopath as having a disorder in the first place. Many would say that psychopaths could not possibly be normal. Maybe so, but how does classifying psychopaths as mentally ill help our understanding or our efforts to improve society? It is probably an unintended virtue of Without Conscience that Hare brings this troubling question into sharp focus.

Internet Articles by Robert D. Hare

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