Ideas - Are psychopaths real? A review of the science says, no

Episode Date: August 3, 2026

Thanks to Dexter and Hannibal Lecter you may think you know what a psychopath is. But a critical review of the science suggests that 'psychopath' as a diagnosis is flawed. Author of Psychopathy Unmasked Rasmus Rosenberg Larsen argues it’s time to end the misuse of controversial science in our criminal justice system — and to rethink psychopathy as a whole.

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When did the idea of psychopathy emerge? Welcome to ideas. I'm Nala Ay. It's an idea that goes far back, at least two centuries. The first or the oldest iteration I've been able to locate is a speech by Benjamin Rush. He's sometimes called the father of American psychiatry. But he proposed there was this disorder where people are ordinarily intelligent and can be quite capable, but they are just not living up to the moral ideals or the moral rules that the society has set.

So this is 1786. For more than 200 years, science and society at large have been fascinated and puzzled by individuals whose behavior flies in the face of established social, ethical, and moral standards. A couple of psychologists use the phrase, they know the words, but not the music. That's a very good description of the psychopath's language. It's the reading a script, but the feeling is really, really not there. Psychopaths are what I would call parasitic predators. They find a target, they latch onto it, and they suck everything out of it that they can.

So you have this idea of an individual who seems normal on the outside, but they have some very masked and very, very deep problems with socializing. Descriptions of psychopaths from the world of science. Then there are the depictions from the minds of Hollywood screenwriters. The point is, ladies and gentlemen, that grie, for lack of a better word, is good. From the fictional Gordon Gecko in Wall Street. Greed is right. Gride works. Tom is one of those people who takes advantage of people.

To the recent chilling, small screen take on Tom Ripley. He's taking advantage of Dickie. The grasping, murderous grifter from Patricia Highsmith's 195 novel, The Talented Mr. Ripley. False IDs, bank letters. What's going on, Tom? I have no idea what you're talking about. And yet, two centuries into the conversation,

what we can say for certain about psychopaths is still up for debate. Why is it that we come out short-handed? We're talking about world-class researchers. We're talking about powerful methods. We talk about powerful technology. all been invested in this. And why is it that we cannot corroborate all these very, very common claims about psychopathy? We're not searching for a needle in the haystack.

We're searching for like a sore thumb that should stick out, right? So do you believe that psychopathy is a zombie idea? I think that there are reasons to believe that psychopathy is a zombie idea. That is Psychopathy Researcher Rasmus Rosenberg-Larsen, the author of Psychopathy Unle. mast, the rise and fall of a dangerous diagnosis. In it, he questions almost everything we think we know about psychopaths. Ideas producer Donna Dingwell spoke to him to find out why. Rasmus Larson didn't start out as a skeptic. In fact, it was quite the opposite. When he started his research in 2012, he was captivated, as so many of us are, by the inner workings of the psychopathic brain.

I myself was deeply fascinated with the idea of psychopathy, and it was only years later that I started to be skeptical about what the field has to say and the idea itself. That skepticism has come with downsides. Go to a dinner party and you say, I study psychopath. Who do you think is going to be the center of attention at the dinner party? You told me you don't tell anyone when you go to a dinner party. Is that true? I mean, I used to, but I don't anymore because the experience is exactly this. people look at you with fascination. When you then tell them that you don't believe it's a thing, then you have a whole other

kind of worms to deal with. But, yeah, it's... You don't get invited back. Yeah, exactly. Like, I'm sure you have students who come in and are very excited about the idea of studying psychopaths and then you squash all of their dreams. No, that's pretty much my job in a nutshell. And they do come in in throws that wants to study psychopathy.

They also want to be criminal profiles and all sorts of things. They open their textbook and there's a full chapter on psychopathy, all citing those studies that are fascinating and so on and leave out all the stuff that shows that it could be the other way around, right? If you are a person who wants to study psychopathy, at least what you should do yourself a favor is to read the research literature carefully. And you should grapple with the fact that none of the class, claims we make about psychotic is still not being corroborated.

Larson is an assistant professor of forensic epistemology and philosophy of science at the University of Toronto, which makes him uniquely suited to grappling. Forensic epistemologist, there's not many of us around. It's really an individual who is sort of a generalist in the sciences. We train in trying to be able to interpret all sorts of sciences and how to draw inferences from the evidence that these sciences produce. And then, of course, the forensic element is that we can make some discernments about how this science should or should not be used in a legal setting. It was a little over a decade ago when Larson began to look more deeply at the quality of academic literature around psychopathy. It's not a coincidence that the

broader field of behavioral science was also confronting an uncomfortable truth at the time. I mean, you kind of come to the conclusion that there's a lot of bad science, it seems like. Is that fair to characterize it that way? Yeah, I mean, I don't want to, you know, let my colleagues out hang and drive. But there's an inconvenient fact about behavioral science in general. Behavioral science has an enormous problem of reproducibility or replication of results. It has led to what we today call the replication crisis. The problem of the so-called replication crisis has been widely covered,

including by the CBC Science Program, Quarks and Quarks. There's a famous quote by Sir Isaac Newton that goes, If I have seen further, it's by standing on the shoulders of giants. This is how science works. It builds upon previous research. But lately, some scientists have been sounding the alarm. They say they aren't standing on the shoulders of giants, they're standing on quicksand, they say there's a reproducibility crisis

that scientists haven't been able to replicate the results of many seminal studies. 90% of all psychopathy research is done in that period. Now, when my research group and I would go out and do research, we actually go a long way to try to identify where these questionable research practices has been implemented in the research. And we find it literally scatter all over. Larson's recent book is a sweeping and systematic review of psychopathy research between 1980 and 2024. The results led him to question whether psychopaths exist at all. The last chapter where you talk about a zombie idea as explaining the lack of scientific progress, but also suggesting that maybe psychopathy isn't actually real. Just kind of talk to me about what a

zombie idea is and how it might apply here. A zombie idea is a term that we scientists use for ideas that has been thoroughly falsified. We know they're not real. We know that they're bad ideas, basically. They are dead. That's the zombie analogy. Yet there is still a large part of the scientific community who somehow still adhere to these idea and find them appealing and worthwhile investigating, right? So the zombie analogy is dead,

but still walking around and is very infectious, right? So it keeps infecting new generations or researchers and then it lives on the sciences. Extremely rare phenomenon, actually, because science is supposed to be an antidote, and it is, in fact, a very powerful antidote to zombie ideas. if we find evidence against things, we're very quick to give up on these ideas, usually. So sometimes we don't. I don't know if you want me to go into some historic examples, but we could. Sure, give me what? So a good example would be biological race.

Okay, so today we are very adept at talking about races or race, for example, white or Latino, Hispanic and so on, as a social construct, as something to do with your idea. identity. You don't have to go further back than 20 years or so, 30 maybe, to be a little bit more generous. People thought it was a biological entity. So they thought that the human species had somehow started to evolve into separate subspecies that we called racist. That idea was shut down. Now, it took at least 20 to 30 years before the majority of biologists had like thoroughly washed this idea out of their research programs. To understand how Larson came to think of psychopathy as a zombie idea, you need to go back

to the time when it first sprang to life. It's something this program explored in detail in a four-part series that first aired on ideas in 2002. Producer Mary O'Connell spoke to some of the leading minds in psychopathy research. Her series was called Creating Conscience, a History of Treating the Psychopaths. For almost 200 years, psychiatrists have wrestled with the idea of the psychopath and the possibility of treatment. 18th century French physician Philippe Pinel was a strong advocate for the humane treatment of the mentally ill. But in his work, Pinel became aware of some patients who struck him as odd, somehow different from the rest.

And he coined a term for their condition. Manis-on-de-lir, madness, without confusion. This was not the psychotic. who, suffering a break with reality, believes a large animal in a green suit is at his window. Penel noticed some patients experienced no hallucinations, voices, or paranoia. He wondered, how could a disorder spare the intellect

but attack one sense of morality? In other words, how could these psychologically intact people, clear-headed, in fact, behave in horrific or simply senseless ways? I thought that madness was inseparable from delirium or delusion, but I was surprised to find many maniacs who, at no period, gave evidence of any lesion of the understanding. While Penel believed there was hope for all patients,

another idea soon took hold, that the biology of these patients was both immutable and easily identifiable. That was outlined in a 19th, 30's textbook, The Essentials of Psychiatry. The brain may be abnormally large or small or defective either in part or as a whole. There may be gross physical defects in the development of the eyes, ears, nose, mouth, rectum and anus. Minor physical defects include abnormal spacing or defective development of teeth, high-arched palate, hair, or cleft palate, webbing of fingers or toes, undescended testicles, and infantile uterus.

Other signs of a psychopath, according to ideas at the time, were tendencies towards homosexuality, lesbianism, cross-dressing, or voyeurism. This belief amongst the biology-based thinkers persisted until the mid-20th century. And if the psychopath was a biologically defective creature, Just born that way, well, the thinking went, psychiatry could do little to help. Post-World War I, a different and arguably the most influential and enduring work on psychopathy emerged. From an unlikely source, says Rasmus Larson. Can you just describe a little bit about who Hervey Cleckley was? Yeah, so Hervey Cleckley, he was not a prolific scholar in any way.

He was actually just a working psychiatrist. But he has left this really interesting imprint on the history. as psychiatry, his name pops up on some really curious crossroads in mental health research. So psychopathy, the psychopathic personality disorder, is obviously one where he had a lot of influence, and his work has been central to how it's conceptualized in research today, and his work is still cited today. But he pretty much only has one book on the topic, plus maybe one or two articles. Cleckley was born in 1903 and graduated from medical school around 1929. He began working with World War I veterans at the VA Hospital in Augusta, which specialized in mental health issues.

It was there, Cleckley began documenting their stories. He was fascinated with patients who he described as charming, bright, and charismatic, but lacking in a moral compass. He published a book about his observations called The Mask of Sanity. in 1941. He has these long, what we today call patient vignettes, each patient, and he describes their life in somewhat detail. A boastful man who engaged in frequent forgeries, petty frauds, and brawling. He was as bright as a dollar, smart as a whip, with a mind like a steel trap.

However, he suffered an appalling deficiency in understanding personal values. And he describes them why. these individuals match onto this diagnosis that he calls psychopathy. He's giving you real clinical cases that he thinks kind of instantiates this concept. She can lie with the straightest face. And after she's found in the most outlandish lies, she still seems perfectly easy in her own mind. She's not hard or heartless, but she's all on the surface.

I obviously don't personally agree with much of what, Cleckley says, but I do recognize that this is how you do mental health research. You look out there in reality. You see some facts, and then you try to make sense of those facts. He used a fabricated story of shell shock to manipulate his way into hospitals. He ran entirely naked through the streets of the town. Many of his patients were in and out of both prison and psychiatric institutions. They didn't fit any standard diagnosis.

All of the horror is in just this, that there is no horror. Cleggley was not unsympathetic. He saw psychopathic patients as an overlooked population, and he thought there were many more of them among us than anyone believed. I have been forced to the conviction that this particular behavior pattern is found among one's fellow men far more frequently than might be surmised from reading the literature. If the nature of the disorder in question defines itself throughout the course of this work with sufficient sharpness and clarity to be recognizable as a pathological entity,

little doubt will remain that it presents a sociologic and psychiatric problem second to none. Despite his compelling prose and dire warnings, the book didn't get much attention on publication, which isn't surprising the debate over the validity of psychopathy that began in the early 19th century had never really gone away. Maybe controversial is not the right term, but people at least disagreed on what it was. All the way into the 1970s, you see a lot of psychiatrists simply just given it, as you say, the label, this is a waste basket diagnosis. This is a diagnosis that psychiatrists they grab onto when no other label seems to be

sufficient, right? So this was, of course, a derogatory claim, right, that it's like you shouldn't use it. So were they saying it should be put in the wastebasket or is that we're just throwing everything we know about it into a wastebasket and as a result it should stay there, I guess? It's kind of both. But you also see a little bit more serious criticisms. So in the 1970s you see a person like Aubrey Lewis, who was a very prominent psychiatrist in England in the UK, who, who said this is the most elusive or poorly defined diagnosis we have at all in our vocabulary. So this is 1974.

Larson says today it's somewhat easy to look at Cleckley's attempt to define the disorder through his patient observations and see limitations. Many of his patients were First World War veterans that had come back from battle and combat in Europe. To a modern reader, when you're reading about his patients, you can't help, of course, just notice is that these people have, like, very powerful PTSD from the war that they have just experienced. Some of them are also substance misusers. There are many that have, like, very, very long history of alcoholism. Homelessness also part of his patient's life and not much stability in their lives

and also have other ailments or illnesses that they're dealing with. Some early critics suggested Cleckley Health stereotypical ideas about male aggression, that he overlooked psychopathic traits in women, although he did add more female patient vignettes in later editions of his book. What I found interesting is that none of the cases he profiles involve particularly heinous or violent crimes. While a few patients commit assaults, they're mainly involved in petty theft, fraud, forgery,

and sometimes just breaking societal rather than legal norms. This was actually later becomes a little bit of a rife between psychopathy researchers, Because Cleckley didn't necessarily think that criminal behavior was like a clear or a common sign even of psychopathic persons. Because he generally saw them as like just fundamentally disinterested. It was just more like happenstance that sometimes they got involved in criminal behavior. Where later, more contender research today would say that that criminal behavior is a very central component. What Cleckley did believe was that you could identify a psychopathic. by studying them.

And to that end, he created a list of 16 traits that made up what he believed was the psychopathic personality. It included superficial charm, intelligence, unreliability, a lack of remorse and insight. He said psychopaths are egocentric and incapable of love, but they do not show signs of delusion. He said there's no explanation for their antisocial behaviors. This is probably one of the true innovations that Cleckley brought to this field.

You look at Cleckley's 16 trade items that he has described, and if you can find those in your patient, well, then you have good evidence that they are, so to speak, psychopathic, right? That's his idea. Yet when Cleckley died in 1984, he was actually better known for his work on another front, a case study of a female patient who had what was then termed multiple personality disorder, or MPD. He and his colleague Corbett Thigpin wrote a book about the woman that became the basis for a Hollywood film. There are three characters and three faces of Eve who occupy one body, female. This female is married.

This is a true story. of the most completely documented case of multiple personality in the history of medicine. The book from which this account was taken. Joanne Woodward won an Oscar for that role in 1957, and the film sparked widespread interest in the disorder among clinicians. Cases exploded again in the 1970s when another doctor's book about an MPD patient,

she called Sibyl, was adapted for television. After that, thick pen and clickly expressed concerns that suggestive clinicians were falsely diagnosing patients. Eventually, multiple personality disorder fell out of favor and was replaced by disassociative identity disorder to more accurately reflect the condition. Hervey Cleckley, a doctor from Augusta, Georgia, wrote his list of psychopathic personality traits in the 1940s.

It was his attempt to better define the disorder and bring it out of obscurity. He wanted to help the medical and legal systems protect society from the, quote, antisocial, heedless, self-damaging, and irresponsible behavior of psychopaths. His overarching goal was more straightforward. He wrote,

If this book sparks further study of this peculiar status among human beings, I shall be abundantly satisfied. Looking for a different kind of summer experience, Experience? Uncover history. Discover Canadian Connections. The Toronto Holocaust Museum is a space for everyone. Use code summer 26 to get 30% off your visit. Admission is free for those under 25. Learn more and book at Toronto Holocaust Museum.org. At Desjardin Insurance, we put the care in taking care of business. Your business to be exact. Our agents take the time to understand your company so you get the right coverage at the right price. Whether you rent out your building, represent a condo corporation, or own a cleaning company. We make insurance easy to understand

so you can focus on the big stuff, like your small business. Get insurance that's really big on care. Find an agent today at dejerdin.com slash business coverage. This is Ideas. I'm Nala Ayad. It would take three or four decades

for Dr. Hervey Cleckley's hope to be realized. But he's now credited with transforming our understanding of the psychopathic mind. It was a Canadian psychologist named Robert Hare, who elevated his work in the 1970s and 80s. With more on how that unfolded, here's Ideas producer Donna Dingwall, in conversation with University of Toronto Professor Rasmus Larson,

the author of Psychopathy Unmast. He comes up with kind of a checklist around how to identify psychopaths and that, as you said, catches the attention of this Canadian psychologist Robert Hare. And so how do their ideas kind of co-mingle and morph, if I can put it that way? Robert Hare, who's a Canadian researcher in the 1970s, looks at Cleckley's work and say, this is really interesting. He has made similar observations and he tries to build on Cleckley's work. And they exchanged ideas. Robert Hare eventually comes up with his own checklist. Robert Hare is in his 90s now and declined an interview for this program.

But in the early 2000s, Ideas producer Mary O'Connell visited him at his office in Vancouver for her series, Creating Conscious. This is your interesting office, lots of character. You mean it's a mess. It's complete and utter mess. A life's work is contained in this basement office. Information going back to the early days in the 1970s, when Dr. Robert Hare remembers psychiatry had stumbled into a black hole

concerning the psychopaths. Back then, Dr. Hare was employed at a British Columbia prison where he recalls the ridicule psychiatrists faced in trying to treat inmates whom prison authorities had written off as just the baddest apples in the bunch. Part of this was, of course, a philosophical, difference of opinion over whether certain people should be helped at all. But there was a deeper problem. The entire field of study was in disarray. Dr. Robert Hare says there was no consistent

measurement tool for psychopathy in the first place. Hair credits Herbie Cleckley's work from decades before that for helping him impose order on the chaos. All of my early research was based upon his conception of psychopathy as indicator illustrated in the mask of Santa so we would use the mask of sanity in a sense as our diagnostic Bible. It worked for seven or eight months at the old BC penitentiary, maximum security institution in New Westminster. I was a lone psychologist in the institution. He saw inmates who, like Cleckley's patients,

seemed disconnected from their actions, though Harris cohort had been convicted of violent crimes. And one of the inmates that came in to me was very casual and easy-go-go-reysed. and simply related to me, he had angry or didn't like his baby crying, so he grabbed it by the heels and slammed it against the wall and just killed it. It was when he was describing this to me that I became very, very concerned because there was a bit of a smile. There was no concern that he had done anything wrong.

He was simply describing what he had done if he kicked the football. Hare turned to Cleckley to make sense of cases like this. He described their working relationship in a documentary about Cleckley's life called A Man for All Seasons. I'd correspond with Cleckley and figure out ways of doing things. And initially we thought, well, we'll divide our subject population up into three groups. Those that definitely fit the criteria described by Herbie Cleckley, those that definitely do not, and then somewhere in between.

And so this is pretty scientific. We had a three-point scale now. The American doctor's work served as a kind of blueprint for the checklist hair developed to assess psychopaths. This turned out to be a 22-point scale that I first described in a scientific journal in 1980, and it caught on.

The Harris Psychopathy Checklist, or PCL, was designed for scientific purposes to bolster empirical rigor by giving researchers a standardized understanding of the disorder. So Hare was surprised when one of his students seemed to find a new use for the test by following psychopaths after their release from jail.

This is what he said on a 2011 National Public Radio Report. Did an excellent job of predicting who would commit another offense within the next couple of years. Those who had low scores on the PCR, about 20 or 25 percent would be reconvicted within four or five years. The high group was 80 percent. Not surprisingly, this caught the attention of, people working in the justice system who wanted to use the checklist. Hare initially said no over concerns about how it might be used. But in 1991, he published a revised checklist, the PCLR, and granted permission.

After that use of the PCLR in the Canadian legal system increased, it went up 858% between the years 2000 and 2013. And when I say spike, it's almost like a vertical, exponential curve. you see. So from year to year, we just see it exploding. So this is just one indicator. But we also just see clinicians are talking about the PCR more and more often. We see training courses being offered in where forensic psychologists can go and become like, quote-unquote, certified in using the PCR. Harris Checklist is used worldwide, and it's lauded as a gold standard in assessment tools. It uses a scale from 1 to 40, a score of 30 is an indicator of psychopathy.

The assessments become so well known. It's even been referenced in network procedural crime dramas. You're testing to see if I'm a psychopath, aren't you? What makes you ask that? I've taken the hair and I've taken the PPI and I am definitely a psychopath. Two years after releasing the PCR, Hare published his first book, Without Conscience, the disturbing world of the psychopaths among us. It drove more interest in the field. In fact, when Rasmus Larson read the book on a flight in 2012, it had a big impact on him. I myself was deeply fascinated with the idea of psychopathy, and that was also what drove me into the field. Larson then read every psychopathy study he could find. By 2015, he was seeing a disturbing pattern.

I remember reading some research articles where it was clear to me that there was some overstatements. So there was like this obvious gap between the data that that was being reported and the rhetoric that they were using. So I was just like, that's odd. He soon discovered researchers with similar concerns and began working with them. This, as mentioned previously, was when this larger conversation about the quality of scientific studies and the inability to replicate their results was brewing. That's in part what led him to write his book, Psychopathy Unmasked, a reply to Herbie Cleckley's book, The Mask of Sanity. Psychopathy Unmased is a tip towards Cleckley.

The metaphor I wanted to capture with psychopathy en masse is that once we start to pick that apart and look under the mask, everything that has been historically claimed about psychopathy from researchers and clinicians that just turn out to not have any clear empirical support. So scientists, you can just say kind of whatever, like eventually we will show that it's wrong. Like science is that powerful, right? of course, we could say the same thing here if it wasn't for the fact that this is being used in the legal system to impact real individuals' lives. If it was just a bunch of academics fooling around at University of Toronto, wherever we are, like, it's a little bit you could be sassy and just say whatever, right? Yeah, this isn't theoretical.

This is not just theoretical work. No, no, that's the problem. Well, the work isn't theoretical. Larson does use an imaginative. inmate to make his point. So if you have a person, let's call him Tom. He has committed an aggravated assault or something along those lines. So all sorts of information is going to be generated about Tom that decision makers down the line can rely on when they make decisions about Tom. And there are all sorts of standard batteries of assessments that individuals like Tom go through. The PCR is often part and parcel of these sorts of assessments. If Tom is deemed a psychopath, Larson says this is what he may face.

Harsher sentences, a higher chance of bail and parole being refused, and he's more likely to be put in a higher security prison. In United States, this diagnosis has also been used to inform capital punishment, so a death sentence. And one way to argue in favor of a death sentence if you're a public prosecutor is to make the argument that the individual who has been found guilty does not have any immediate chances for improving. So a PCR score has often been used to make that argument.

In Canada, Tom might be declared a dangerous offender, which comes with an indeterminate sentence. These are all grave consequences, and yet I can't help asking, isn't going to bat for convicted criminals who've already shown a propensity for violence and who might be psychopaths, kind of a hard sell. There's lots of people in the justice system who, you know,

it's easy to make a case for why we should feel they've gotten a raw deal, but it's a lot harder in this situation, perhaps. It is that the person who's going to score high on the PCR is not going to be a person that you want to go out on a date with or have a close relationship with for all sorts of reasons. And so there's not going to be much sympathy in the same. system for that person, whether they are treated wrong or not, right? I think that's wrong. Like, justice is justice. We should live up to our principles that we set ourselves. But we don't.

That bothers me. It bothered him to such an extent that he and his team have spent a decade reviewing studies related to psychopathy to see if the science holds up. Based on that research, his book takes on five core ideas. What we think we know for certain about people like Tom, his hypothetical psychopath. And there are five common claims that are typically being used in the legal system. One of them is that Tom is now going to be perceived as a very high risk or extremely dangerous individual, meaning that if we compare Tom to any other average non-psychopathic person, we have this assumption that he is now much more dangerous than these other individuals because of his diagnosis.

We also, psychiatrists often, assuming that psychopathy is also untreatable. It's a chronic state, meaning that he will remain dangers for the remainder of his life. We will also make all sorts of assumption about Tom that he has some sort of deprived morality, which, of course, goes back to the claims about lacking empathy and remorse and so on. We assume that it has some sort of a biological condition. This has often been claimed by researchers that it's a neurological or neurodevelopmental condition. And fifth, psychopathy is not just a label. There's also a sound scientific theory behind it, what is actually how we account for, how we explain this disorder.

You know, you start with that psychopathic persons are extremely dangerous, which for most people, I think, seems to be a given. This is for a lot of people a little bit of a non-starter because they would say in ordinary speech, and there's nothing wrong in thinking about it in this way. But ordinarily people would say, well, if you're not extraordinarily dangerous, you're also not a psychopath, right? And that's all fine and good. But, you know, as a scientist, this is really not the way we do research. What we do is that we say those people that you claim are a psychopath, let's test how dangerous they are. to other justice involved individuals who are not psychopathic, right? To that end, Larson's team reviewed 20 studies to determine how often people the PCLR ranked as psychopaths reoffended after release from jail compared to non-psychopass.

In the vast majority of cases, the psychopaths and non-psychopass had the same amount of reconvictions. It's a predictor, but this is not what we're talking about. We're talking about whether it's an extraordinarily good predictor, and the answer is just emphatically no. So we have different risk assessment tools at our disposal. The PCR is actually not the best predictor of crime. To be clear, that doesn't mean those individuals are not violent or dangerous. We do not mean it compared to, you know, Brian who lives, you know, in Mississauga and has never done anything. That's not what we mean by saying extraordinarily dangerous.

We mean it as a relative claim within the justice, justice-involved population, right? Well, Larson's book uses systemic reviews of literature to test the strength of empirical evidence. He says there is a particular study that deserves attention. It's regularly cited as evidence that psychopaths don't benefit from treatment. The last time Jim Mutherall went through these gates, he was a prisoner on his way to Ontario's Oak Ridge Psychiatric Hospital for treatment. What he got instead, he says, was torture. That's where it was right there. This is a place that destroyed a lot of lives, including mine.

He spent the decades since leaving Oak Ridge with one wish that the doctors who subjected him and other patients to years of abusive treatments here would finally face accountability. That's a clip from CBC's The Fifth Estate. The episode told the story of patients who were part of experimental and involuntary treatments carried out at a maximum security forensic mental health facility between 1963 and the 1980s. Oakridge and Penitanguishing, Ontario, housed many notorious offenders. Some deemed criminally insane. That's where the study took place.

It's a study from 1992. These were three in-house researchers. They did not execute a treatment themselves, but they've reviewed the data from a treatment program that had been running at their institution for a little bit more than a couple of decades. Perhaps the darkest chapter in Canadian forensic psychiatry, I don't think that's an overstatement. What was happening in the institution was horrid experimentation with all sorts of treatment methods. And they would forcefully inject, you know, really powerful psychoactive drugs like scopolis, scopolamine and so on, into patients without their consent. And they would have like very horrible programs where they would chain people together, strip them naked, let them like go to the bathroom and sleep for,

you know, up to two weeks. There was this kind of idea that you could kind of regress someone back to being a child and then they would relearn how to have empathy and there was patients treating patients with this idea that they could, you know, learn empathy, I guess, from, as you say, being chained together, having to help each other. Patients were also helping or assisting staff in treating patients, but patients were also involved in writing records at the institution. The data that the researchers took for the 1992 study is actually also produced by patients who were, you know, some of them were schizophrenics and so on. It was just like a wild, you know, West sort of data set.

In 2021, a court awarded 28 former patients just under $10 million in damages. It said the program, which also included sleep deprivation and solitary confinement, amounted to torture. The 1992 study that came out of that time is still being cited today. There are two psychopathic groups. The one received treatment and the other did not.

those who did receive treatment had higher violent recidivism rates compared to those who did not receive treatment. So this was looked at as like a clear sign that not only is there nothing you can do, but you can actually, you know, exacerbate the situation. That was sort of the explanation for why these people who were treated were then going out and reoffending. That psychopaths were so wily that they were actually learning how to outsmart. the people treating them. And that became kind of like a mantra in the 1990s. You see it reiterated and discussed in detail in the PCLR manual.

It's one of the most cited studies in psychopathy research, right? It's very unfortunate. It's a study should have been retracted many years ago. It's still not retracted. Today, Larson says there is almost unanimous agreement among researchers that psychopaths can benefit from treatment as much as non-psychopathic offenders. And empirical studies have consistently documented positive effects. since the mid-90s.

For several decades, researchers have also touted studies using machines that measure things like heart rate, brain waves, breathing, and skin reactions in response to various triggers. To back up the theory that psychopaths are cold and unemotional. There is an idea of a Patrick Bateman, some kind of abstraction, as embodied by the character of Patrick Bateman in American society. And though I can hide my cold gaze, and you can shake my hand and feel flesh gripping yours, and maybe you can even sense our lifestyles are probably comparable. I simply am not there. But Larson found the data actually shows that psychopath's bodies react pretty much the way the rest of ours do to those triggers. There was a similar lack of evidence to support the theory that psychopaths can't control their impulses.

One of the other long-standing debates in psychopathy research boils down to nature versus nurture. Is a psychopath born or made? And of course, it makes sense to look in the brain or look at your genetic makeup and so on. One line of research that I review extensively in the book is the MRI or the magnetic resonating imaging technology where we can get a peek into a living brain.

So it's a strict. structurally different? Is it functioning in different ways? It's neurons firing in different areas of the brain in psychopathic persons when they do a certain task compared to controls and so on. We have close to a hundred of those studies today. Nothing that has been replicated clearly in this field. Yeah, Larson says findings that suggest there's no link between brain disorders and psychopathy are largely ignored in favor of more sporadic findings that support the idea. And those, are more likely to be reported by media outlets. And there is no denying our sense of who psychopaths are is shaped by media and popular culture. Just like that, I made two grand. The other guys looked at me like I'd just discovered fire.

I was selling garbage to garbage men and making cash hand over fist. The ruthless stockbroker, like the one played by Leonardo DiCaprio in Wolf of Wall Street, is just one example. Their money was better off in my pocket. I knew how to spend it better. Excuse me.

We also talk about individuals who are often described as somehow lacking a moral compass or being morally colorblind or being without conscience. There's all sorts of terms that are being used. Corporate psychopathy was popularized with the publication of the 2006 book, Snakes in Suits, When Psychopas Go to Work. It was written by Robert. Hare, an organizational psychologist Paul Babiak. When Larson looked at the empirical evidence behind the idea that psychopaths lack empathy,

he found it lacking. There are 66 period studies that has been published since the 1980s with the sample size, an aggregated sample size that is quite large. What this research has found is somewhat surprising to a lot of people. most of it, to put it very briefly, it's just null results. But overall, the conclusion here is pretty close to that we can say that maybe this notion that psychopaths lack empathy, well, that is probably one of those that we can say has been thoroughly falsified when we look at this evidence here. Null findings, poor data sets, and spin aside, there still is the very real issue,

that the criminally involved individuals we label or mislabel as psychopaths still exist. And that raises a lot of questions. For the person listening, it's kind of alarming to think that this structure that we've created for these people doesn't hold up. So then what do we do with them? What are we to make of this being used in our court system? And how can you possibly move away from it? It's a lot to kind of wrap your head around because you do suggest that. that there's an ethical argument not to use the PCR anymore

and that maybe we shouldn't be categorizing people as psychopaths. So then what do we do with them? I do think that forensic psychologists and psychiatrists, the forensic nurses, so on, that do have an ethical responsibility not to use something like the PCR or even use the diagnostic label of psychopathy in their practices. What do we do now? Because we are using it.

and so people who get this label of psychopathy on them, there will be decisions made about them. And sometimes they're going to be based on this idea that they are incorrigible, that they're extraordinarily dangerous and so on because of that label. And in some cases, it's going to be absolutely the case that that person is not going to be really dangerous or incorrigible, right? And that has to stop. It could be that in some of these cases that the person has been, rendered high risk for other reasons.

Okay, we can talk about that. But in cases where the psychopathy label is used in this wrong way, and that to me is a case of injustice. There's no other way to really put it. So are you making an argument or is there an argument for just more individualized treatment rather than trying to use a checklist and put someone in a category? I'm advocating for evidence-based practices broadly. Whatever tools you use or whatever mechanism framework you're using to inform your decision-making,

that has to be based on empirical evidence to the best that we can, right? If you want to select the people who are most prone to benefit from treatment, there are tools for that. If you want to select people who are more prone to violent and recidivate, there are tools that are better for that. I mean, I could imagine, and I know this isn't empirical in any way, but someone like Robert Hare or anyone who has, you know, made a career out of doing this kind of profiling saying to you, and I don't know what, you know, all of your experience is, but I've sat across the table from these people and I've analyzed them and I've gotten to know them. And so, therefore, I have a better understanding than someone who's just reviewing evidence or, you know, criticizing what I've done. I've heard that many times. It's usually not a response that behavioral scientist or even, I would say, forensic, psychology or practicing would take seriously because evidence-based practices is indeed also that you should make room for the experience of the clinician.

So this is where I specialize. I don't specialize in sitting across the person and interviewing them and I think it might bias my view. so I want to look at the data instead. I think that's much more powerful. The bigger and more philosophical issue at play in all of this, Larson says, is our propensity as a society to label behavior, like violence, that falls outside of what we see as normal. And that goes back to the earliest days of psychopathy research.

For example, Benjamin Rush believed if you were drunk and if you did not go to church, and you were promiscuous and so on, that was a good sign of psychopathy, right? Today we would say, oh, that's probably just within the realm of normal behavior, and that was pushed towards violence, right? There's something like that stands out when it comes to violence. You write in the book numerous scholars have pointed out perhaps the most fascinating and terrifying aspect about human violence and destruction is the ease at which ordinary people

readily engage in it. Yeah. And so that this is a way of separating ourselves from that, Yeah, I think you hit the nail on the head there. I think we want to tell a story where we are the good guys, right? And those who do unsavory, bad things, there must be something wrong with them. If we want to be serious about human on human violence, you cannot ignore the fact that the vast majority of really nasty violence that you see in conflict zones or in organizations. organized societies that has not falling apart due to war, like is usually conducted often in the name of doing good, or it's just, you know, something that good people are easily capable of doing. It gets really pronounced when you look at genocides. What scholars always point out, and these are not psychopathy researchers, these are anthropologists and so on, what they point out

is that genocides are committed by ordinary folks, and they go home and they kiss their children goodnight. They love their husband or wife, and they are ordinary carpenters, electricians, baseball coaches, and they have perfectly capable of loving hatred and also killing. That's a scary observation, but is nevertheless a fact-based observation. On a less philosophical note, Larson says he is, seeing a shift in how the legal system is assessing these behaviors and using the psychopathy checklist. The anecdotal evidence suggests that there are many forensic psychologists across the world who have stopped using the PCR. I was recently, for example, together with practitioners from the UK,

and they said that had more or less stopped using the tool there. If you look at the hard data, in last year, we published a study where we looked at the use of the PCR. in Canadian court system. Just like in the United States, a very quick explosion in the 2000s. But then the case numbers actually peak in 2013, and then you see that it has turned. And now it's actually nose diving. It's still very high. But it is nevertheless nose diving.

Robert Hare no longer holds the copyright for the PCR. The consulting and research group he founded, which trained people to use the checklist and got royalties from its use was sold to another company in 2019. But as for the field entertaining a major rethink on the very idea of psychopathy, Larson knows that it is a tall order. Human behaviors are extraordinarily complicated, and it doesn't lend itself easily to scientific inquiry. Like, it's not that easy.

And that's really just what we're saying. What critics of psychopathy is saying that that story you gave us and that idea, is far too simplified. Now, today, we can say with confidence that I think you might be wrong about this. Look at the research. Show me the evidence. And he can point to a precedent,

and it's one involving, Hervey Cleckley, the architect of our modern day understanding of the psychopath. This would not be the first time that psychiatry or mental health research has been wrong about a disorder. Most recently, perhaps,

would be multiple personality disorder that after several decades of research, we figured out that we had just completely misunderstood this phenomenon, and the diagnosis of multiple personality disorder was eventually discarded by the clinical community. I think that maybe psychopathy might be the next disorder to leave our nomenclature. That's the conclusion of today's episode of ideas titled

Psychopathy Unmast. This episode was produced by Donna Dingwong. Thank you to Professor Rasmus Rosenberg-Larsin, the University of Toronto, Mississauga, Mary O'Connell, the CBC's The Fifth Estate, and the producers of Hervey Cleckley, a man for all seasons. Technical production by Emily Kiervezio and Danielle Duval. Our web producer is Lisa Ayuso, Senior producer Nicola Luxchich. Greg Kelly is the executive producer of ideas, and I'm Nala Ayyad.

For more CBC podcast, Go to cBC.ca slash podcasts.