Psychopathy

Definition

The psychopathy is a deviating process of the development, which results in a disorder functional of the personality, one of the chief features of which is an excess of instinctual aggressiveness and an incapacity to tie object-relationships. The term of psychopathy represents at the same time a category, a diagnostic class, and a continuum of psychological disturbances, whose intensity and nature are variable from one individual to another in terms of treatment in particular. (J. Reid Meloy)

Theoretical context + semiological

Let us retain initially that the term “psychopathy” thus conveys a concept of disorder of character with important historical implications and private clinics:

the American current is based primarily on a symptomatologic approach; thus in the DSM IV of American Psychiatric Association the criteria recover only the antisocial personality disorders, directed towards criminality; the transgression of the law is a key element of diagnosis of psychopathy with HAVE, but in France this report/ratio with the law appears as one of the semiological elements but not exchange because so much of psychopathes are delinquents because privileging the passages to the act with the detriment of any mental development, often with legal consequences, all the delinquents are not psychopathes (Diatkine). Nevertheless, in S `pressing on these criteria and those released by Hare and Al (1991), Meloy (2001) could establish certain characteristics of personality of the criminal psychopathes: an absence of anxiety or concern, an aggressive and real devaluation of others which make it possible to support lived of one the oneself imposing one and to repair the emotional wounds, an omnipotent control on the others, a surface charm associated with an unquestionable facundity, a relational insensitivity, a lack of remorse, as well as a terrible and worrying trouble.

One can note in addition that Meloy, while giving to the foreground an alive private clinic, raised the question of the object-relationships at the subjects psychopathes, in the tradition of Melanie Klein, Jacobson or Kernberg. Indeed, while affirming a psychobiological predisposition necessary to psychopathy, it was interested in the primary education experiments of object lived like defective and conflict; the origins développementales of the psychopathic personality are characterized by an early separation of with the primary education relative during the symbiotic phase of maturation, of the defects of internalisation, a prevalence of a archetypic identification to object-oneself foreign, a failure in the constancy of the object and the primary education narcissistic attachment with self imposing and finally an aggressive and sadomasochistic mode in the relation with the other.

Following the example Kernberg which places psychopathy in a serious alternative of the narcissistic personality disorders (themselves registered in a function and an elevated level of the organization limits) while being based on the aggressive impulses but with constitutive data, Europeans primarily developed a structuralist or organisational approach of psychopathy; P. - C. Racamier will speak about perversion narcissistic while Balier, psychoanalyst lacanien, distinguished perversion (later deficiencies thus beginning of development and symbolism from where the return tickets between major depression and megalomania, one would be there rather in the limiting States) from the perversity, which joined then what others call psychopathy, with extreme parental deficiencies. The subject psychopathe would pass to the act to avoid the alarm clock of the trace of a threat of invasion by the maternal image.

For other, like Bergeret, the limiting organization will include what others call psychopathy because certain signs the such factitious character, operation out of forgery self-service of the borderline resound with the features of simulation, imitation and imposture of American semiology. This being known as, of many work showed that the psychopathic personalities and borderline were different from a point of view of the clinical examination, therapeutic access and of its installations, the comorbidity of both being of better forecast.

Lastly, the majority of the authors agree however on the narcissistic economy in the middle of psychopathic operation: the object-relationship is marked by the aggressive impulse and its derivatives, by research of being able and control, with an important fight against the dependence and a systematic devalorization of L `other.

The maintenance of one oneself imposing, to protect the subject from the tests related to the doubt of oneself, then require the installation of more or less antiquated mechanisms of defense, containing cleavage, of refusal, projective identification, rationalization, projection, identification with the aggressor and omnipotence.

Moreover, traditional description makes passage to the psychopathic act a substitute of the thought and to a deficiency mental development, a failure of symbolization allots it, an instinctual discharge with incapacity to differ satisfaction. However, certain authors showed that at some psychopathes serious, one would be vis-a-vis a pathology of the action and not of mentalisation (Andronikof, 2001) with aggressive passages to the act at the time of moments of dissociation.

Evaluation

Clinical maintenance remains the privileged tool of the French clinician. Nevertheless, there exist various tools to evaluate psychopathy:

the Scale of Psychopathy of Hare and Al which distinguishes two great factors: the first concerns the emotional and pathological detachment narcissistic and the second the antisocial behaviors and of impulsiveness; however, beyond forty, these last behaviors tend to decline (the age would be thus a therapeutic ally).

Rorschach, integrated system of Exner, very much used in this field, made it possible for example to release a pattern of psychopathic answers with a setting in front of pathological narcissistic characteristics (grandiosity and perception egocentric person of oneself, omnipotence etc) and a marked emotional detachment (Ganaco, Meloy etc).

Other researchers, thanks to the use of Rorschach-Exner, validated the assumption of a conflict between high personal value and image of oneself deteriorated (Réveillère, Pham).

Psychopathy and Sociopathie

According to Robert Hare, the difference between psychopathy and sociopathy can be explained by the origin of the disorder. The majority of the sociologists, the criminologists and even certain psychologists think that the disorder is explained by social environment and prefer speech of " sociopathes". Those which, like Hare, think that the disorder is explained by a combination of psychological factors, biological, genetic and environmental will use the " term preferably; psychopathe".

According to David Lykken, psychopathy and the sociopathy are two demonstrations different from the disorder of the antisocial Personnalité. It advances that the psychopathes are born with particular psychological characteristics like impulsiveness or the absence of fear, which lead them to seek the risk and make them unable to integrate the social norms. By opposition, the sociopathes have a temperament more " normal" ; their personality disorder is due more to an unfavourable social environment (parents absent, close delinquent, Pauvreté, extremely weak or developed intelligence). These two personality disorders result from an interaction of genetic factors and factors environmental, but psychopathy is due especially to hereditary factors, while the sociopathy is due especially to environmental factors.

Therapeutic

Psychopathy is often described like incurable; certain factors have nevertheless an influence on the effectiveness of the treatments of the psychopathes: a capacity, even precarious, to set up a relation of alliance, a depressive comorbidity or signs of depressivity, a receptivity with the supporting family relations.

One can briefly describe several approaches (whose one does not suppose effectiveness):

medication within a framework therapeutic said “institutional or Community” which inhibits certain symptoms, like aggressiveness.

the family therapy can allow a reduction of the repetitions of criminal acts by centering the therapy on the management of the situation by the parents.

the Community therapy which is based on the bond between the members of the group, while being subjected to the authority of this group, by reward system or of sanctions. A therapeutic regulation is done within the meetings day laborers. The group of Darkstone research thus proposes a therapeutic program based on an environment in particular supporting the socialization and the neutralization of the prédélinquantes attitudes.

to reduce the impulsive and antisocial behaviors, one can propose a multiple cognitivo-behavioral approach: management of oneself individual, work on the social aptitudes, prevention of aggressive behaviors. Templeman and Al propose for example a therapy by roleplays and operationnalisation of problems to treat the cognitive distortions.

the poverty of the primary processes and handling specific of the subjects psychopathes led the therapeutists of psychoanalytical obedience to modify the framework in order to alleviate the excitations; it will be a question here of being active to reach the conditions which make possible the emergence of the thought, the affects, the representation of oneself involving an identification with the other and empathy: the patient can then revive the traumatic states, this time without collapse, since it would feel consolidated in his basic narcissism by the emotional division of empathic nature of his experiments with the clinician.

One can raise finally that the majority of the authors agree on the importance of control, the control and the management of the reactions against tranferential of the therapeutist; the risk being for this last to feel devalued, misled, attacked, or to believe in a therapeutic alliance which does not exist what will sully the therapeutic project.

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