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Psychiatric Times. Vol. 19 No. 1
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The Hidden Suffering of the Psychopath

By Willem H.J. Martens, M.D., Ph.D. | December 31, 2001
Dr. Martens is director of the W. Kahn Institute of Theoretical Psychiatry and Neuroscience and advisor of the Forensic Psychiatry Hospital in Assen, The Netherlands.

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Psychopathy is characterized by diagnostic features such as superficial charm, high intelligence, poor judgment and failure to learn from experience, pathological egocentricity and incapacity for love, lack of remorse or shame, impulsivity, grandiose sense of self-worth, pathological lying, manipulative behavior, poor self-control, promiscuous sexual behavior, juvenile delinquency, and criminal versatility among others (Cleckley, 1982; Hare et al., 1990). As a consequence of these criteria the psychopath has the image of a cold, heartless, inhuman being. But do all psychopaths show a complete lack of normal emotional capacities and empathy? Like healthy people, many psychopaths love their parents, spouse, children and pets in their own way, but have difficulty loving and trusting the rest of the world. Furthermore, psychopaths do suffer emotionally as a consequence of separation, divorce, death of a beloved person or dissatisfaction with their own deviant behavior (Martens, 1997).

Sources of Sadness

Psychopaths can suffer emotional pain for a variety of reasons. Like anyone else, psychopaths have a deep wish to be loved and cared for. This desire remains frequently unfulfilled, however, as it is obviously not easy for another person to get close to someone with such repellent personality characteristics. Psychopaths are at least periodically aware of the effects of their behavior on others and can be genuinely saddened by their inability to control it. The lives of most psychopaths are devoid of a stable social network or warm, close bonds.

The life histories of psychopaths are often characterized by a chaotic family life, lack of parental attention and guidance, parental substance abuse and antisocial behavior, poor relationships, divorce, and adverse neighborhoods (Martens, 2000). They may feel that they are prisoners of their own etiological determination and believe that they had, in comparison with normal people, fewer opportunities or advantages in life.

Despite their outward arrogance, inside psychopaths feel inferior to others and know they are stigmatized by their own behavior. Although some psychopaths are superficially adapted to their environment and are even popular, they feel they must carefully hide their true nature because it will not be accepted by others. This leaves psychopaths with a difficult choice: adapt and participate in an empty, unreal life, or do not adapt and live a lonely life isolated from the social community. They see the love and friendship others share and feel dejected knowing they will never take part in it.

Psychopaths are known for needing excessive stimulation, but most foolhardy adventures only end in disillusionment due to conflicts with others and unrealistic expectations. Furthermore, many psychopaths are disheartened by their inability to control their sensation-seeking and are repeatedly confronted with their weaknesses. Although they may attempt to change, low fear response and associated inability to learn from experiences lead to repeated negative, frustrating and depressing confrontations, including trouble with the justice system.

As psychopaths age they are not able to continue their energy-consuming lifestyle and become burned-out and depressed, while they look back on their restless life full of interpersonal discontentment. Their health deteriorates as the effects of their recklessness accumulate.

Emotional Pain and Violence

Social isolation, loneliness and associated emotional pain in psychopaths may precede violent criminal acts (Martens, 2000, 1999, 1997; Palermo and Martens, in press). They believe that the whole world is against them, eventually becoming convinced that they deserve special privileges or rights to satisfy their desires. As psychopathic serial killers Jeffrey Dahmer and Dennis Nilson expressed, violent psychopaths ultimately reach a point of no return, where they feel they have cut through the last thin connection with the normal world. Subsequently their sadness and suffering increase, and their crimes become more and more bizarre (Palermo and Martens, in press).

Dahmer and Nilsen have stated that they killed simply for company (Palermo and Martens, in press). Both men had no friends and their only social contacts were occasional encounters in homosexual bars. Nilsen watched television and talked for hours with the dead bodies of his victims; Dahmer consumed parts of his victims' bodies in order to become one with them: he believed that in this way his victims lived further in his body.

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by jason unsworth | January 04, 2011 3:28 AM EST

the emphasis has been on the psychopath who runs foul of the law (i.e., the serial killer in the provided examples) but we should not forget the middle class & corporate, high functioning psychopaths--those who are in medical practice, work in the stock exchange, police force etc. Such high functioners often go unrecognized until they present for treatment for mood disorders and the like. I have met such callous individuals who meet criteria for psychopathy but never run foul of the law.

by Chevies Newman | December 26, 2010 10:06 AM EST

Great Article. It is likely that much of the issue begins between birth and 2 y.o. This time frame sees the brain grow from roughly 400 gums to 1000 grams. The maternal "looping" phenomenon in which mothers are able to do the ga ga teaches social timing. If mom stressed and cannot even fake it, then this critical period of development, depending on genotype, creates high anxiety levels. Some children overcome and adapt but some find themselves on the outside looking in. This is lonely. The early antisocial behavior is likely stress relief. The thinking that evolves around a life of exclusion can truly be horrifying. Support for at risk mothers and early education in a warm environment, early mental health therapy to enhance and develop empathy by brain development would improve the lives of everyone, even those who eventually end up with the horrifying external expression of the internal state seen before all. We are all taken back. But it is the brain, deprived, hungry and desperate. As the adult with this problem, where is the starting point of reconstruction? Get on medicine, (something will help), because the obsession will increase with stress. Ensure your regimen helps with anxiety, make sure you are Asllep when supposed to be and awake when supposed to be. If not, you are not adequatley treated. Step 2 would be to refrain from harming others. Find other outlets if possible but treat the obsessions like obsessive compulsive disorder. Find the mythology, or change the one you have, to begin a new reconstruction. At least do step 1, this wll help to at least feel better and reduce obsession, if so the compulsion will get better and new learning occur. Good luck, if this is your issue, you are reading about it and thus must have a spark of hope.

by what unlisted | December 23, 2010 3:55 PM EST

The rest of these crying out comments, get help. 

by what unlisted | December 23, 2010 3:51 PM EST

edit*

prejudice is ridiculous. psychopathy and sociopathy are not currently mood disorders, but could be considered one, one day due to the total lack of mood all the time  and emotionless time periods in the psychopath  and the emotionless and moodless time periods in the sociopath. 

by what unlisted | December 23, 2010 3:50 PM EST

prejudice is ridiculous. psychopathy and sociopathy are not currently mood disorders, but could be considered one, one day due to the total lack of mood all the time  and emotionless time periods and the emotionless and moodless time periods in the sociopath. 

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