For the rest of us it is unimaginable that these men were so lonely -- yet they describe their loneliness and social failures as unbearably painful. They each created their own sadistic universe to avenge their experiences of rejection, abuse, humiliation, neglect and emotional suffering.
Dahmer and Nilsen claimed that they did not enjoy the killing act itself. Dahmer tried to make zombies of his victims by injecting acid into their brains after he had numbed them with sleeping pills. He wanted complete control over his victims, but when that failed, he killed them. Nilsen felt much more comfortable with dead bodies than with living people -- the dead ones could not leave him. He wrote poems and spoke tender words to the dead bodies, using them as long as possible for company. In other violent psychopaths, a relationship has been found between the intensity of sadness and loneliness and the degree of violence, recklessness and impulsivity (Martens, 1999, 1997; Palermo and Martens, in press).
Self-Destruction
Violent psychopaths are at high risk for targeting their aggression toward themselves as much as toward others (W.H.J.M., unpublished data). A considerable number of psychopaths die a violent death a relatively short time after discharge from forensic psychiatric treatment due to their own behavior (for instance as a consequence of risky driving or involvement in dangerous situations) (Black et al., 1996; Martens, 1997). Psychopaths may feel that all life is worthless, including their own (Martens, 1997; Palermo and Martens, in press).
Treatment Developments
In the last decade, neurobiological explanations have become available for many of the traits of psychopathy. For example, impulsivity, recklessness/irresponsibility, hostility and aggressiveness may be determined by abnormal levels of neurochemicals including monoamine oxidase (MAO), serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA), triiodothyronine (T3), free-thyroxine (T4), testosterone, cortisol, adrenocorticotropic hormone (ACTH), and hormones of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes (W.H.J.M., unpublished data). Other features like sensation-seeking and an incapacity to learn from experiences (Lykken, 1995) might be linked to cortical underarousal (Martens, 2000, 1997; Zuckerman, 1994). Sensation-seeking could also be related to low levels of MAO and cortisol and high concentrations of gonadal hormones, as well as reduced prefrontal grey matter volume (Raine, 1996; Raine et al., 2000; Zuckerman, 1994). Many psychopaths can thus be considered, at least to some degree, victims of neurobiologically determined behavioral abnormalities that, in turn, create a fixed gulf between them and the rest of the world.
It may be possible to diminish traits like sensation-seeking, impulsivity, aggression and related emotional pain with the help of psychotherapeutic, psychopharmacological and/or neurofeedback treatment.
Long-term psychotherapeutic treatment (at least five years) seems effective in some categories of psychopaths, in so far as psychopathic personality traits may diminish (Dolan, 1998; Dolan and Coid, 1993; Sanislow and McGlashan, 1998).
Psychotherapeutic treatment alone may be insufficient to improve symptoms. Psychopharmacological treatment methods may help normalize neurobiological functions and related behavior/personality traits (Martens, in press, 2001, 2000). Lithium is impressive in treating antisocial, aggressive and assaultive behavior (Bloom and Kupfer, 1994; Sheard et al., 1976; Tupin et al., 1973). Hollander (1999) found that mood stabilizers such as divalproex (Depakote), selective serotonin reuptake inhibitors, monoamine oxidase inhibitors (MAOIs) and neuroleptics have documented efficacy in treating aggression and affective instability in impulsive patients. To date there have been no controlled studies of the psychopharmacological treatment of other core features of psychopathy.
Cortical underarousal and low autonomic activity-reactivity can be substantially reduced with the help of adaptive neurofeedback techniques (Martens, 2001; Raine, 1996).
Case Study
