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Published in final edited form as: Synth Philos. 2010 Feb;24(2):337–348.

Moral Understanding in the Psychopath*

Luca Malatesti 1
PMCID: PMC3000603  EMSID: UKMS31856  PMID: 21151766

Abstract

A pressing and difficult practical problem concerns the general issue of the right social response to offenders classified as having antisocial personality disorder. This paper approaches this general problem by focusing, from a philosophical perspective, on the still relevant but more approachable question whether psychopathic offenders are morally responsible. In particular, I investigate whether psychopaths possess moral understanding.

A plausible way to approach the last question requires a satisfactory philosophical interpretation of the empirical evidence that appears to show that psychopaths fail to draw the distinction between conventional and moral norms. Specifically, I will consider a recent philosophical debate polarized between supporters of rationalist and sentimentalist accounts of moral understanding. These opponents have discussed whether the case of psychopathy offers empirical support for their account and undermine the rival view. I will argue that the available empirical data leave the outcome of this discussion indeterminate. However, this implies that both these principal theories of moral understanding, if independently motivated, would imply that psychopaths have certain deficits that might affect their moral understanding and, consequently, their moral responsibility.

Keywords: psychopathy, moral responsibility, moral understanding, rationalism, sentimentalism, psychology of moral understanding, conventional/moral norms

1. Introduction

A pressing and difficult practical problem concerns the general issue of the right response to offenders classified as having antisocial personality disorders. In UK, for instance, the government proposed the preventive civil commitment of people with this type of disorder (The Home Office 1999). This proposal has generated a wide debate, faced many criticisms and, finally, has been rejected (Cordess 2002; Moran 2002). In this discussion, it has emerged the persuasive suggestion that deciding how to respond to this class of offenders should require, amongst other types of legal and practical considerations, an evaluation of their moral responsibility (McMillan 2003).

This paper addresses the question whether psychopathic offenders are morally responsible for their crimes by considering whether they possess moral understanding. This appears to be a relevant and approachable issue within the general practical debate mentioned above.1 Several philosophers have approached the problem of the moral responsibility of psychopaths by considering whether they possess moral understanding.2 Moreover, due to the work of the psychologist Robert Hare, focusing on psychopathy appears to be more promising than considering the general notion of antisocial personality disorder.3 In the last three decades, Hare has offered and investigated an operational refinement of Harvey Cleckley's classical clinical characterization of psychopathy (Hare 1991, Cleckley 1976). Hare's notion of psychopathy demarcates a relevant subgroup amongst the individuals that are classified as having antisocial personality disorder (ASPD) by the Diagnostic and Statistical Manual for Mental Disorder (DSM IV) (American Psychiatric Association 1994). Hare's diagnosis of psychopathy appears to be a unifying construct in a growing number of psychometric, neuropsychological and neurological studies that appear to support its plausibility and fruitfulness (Patrick 2006, Blair, Mitchell, and Blair 2005).

The main thesis of this paper is that certain philosophical attempts to argue for the conclusion that psychopaths lack moral understanding are unsatisfactory. These proposals share the methodological assumption that this conclusion should derive from the adoption of either sentimentalist or rationalist accounts of moral understanding. Against this strategy, I will argue that the functional impairments of psychopaths are consistent with both these views on moral psychology.

2. Psychopathy

The term ‘psychopath’ has an imprecise current usage. Moreover, it has been employed in the history of psychiatry in connection with different diagnostic practices. Here ‘psychopathy’ will be used to refer to the notion formulated by Robert Hare. In the Seventies he began refining the concept of psychopathy elaborated in the seminal work of Harvey Cleckley. Hare's research culminated in the formulation of the Psychopathy Checklist Revised (PCL-R), a qualitative diagnostic tool that aims to establish how a subject scores along different dimensions encompassing behavioural criteria and personality traits (Hare 1991).

The PCL-R is used to evaluate a subject along 20 items: (1) Glib/superficial charm, (2) Grandiose sense of self-worth, (3) Need for stimulation/proneness to boredom, (4) Pathological lying, (5) Conning/manipulative, (6) Lack of remorse or guilt, (7) Shallow affect, (8) Callous/lack of empathy, (9) Parasitic lifestyle, (10) Poor behavioural controls, (11) Promiscuous sexual behaviour, (12) Early behavioural problems, (13) Lack of realist, long-terms goals, (14) Impulsivity, (15) Irresponsibility, (16) Failure to accept responsibility for own actions, (17) Many short-term marital affairs, (18) Juvenile delinquency, (19) Revocation of conditional release, and (20) Criminal versatility.

The PCL-R is applied via semi-structured interviews and intensive study of the files concerning the history of the subject. For each element in the list, there is a score varying between 0 to 2 points. The maximum total score is thus 40 points; when a subject obtains a value of 30 or more points he/she is considered psychopathic.4 Factorial analysis studies show that the values of variables in PCL-R can be located on three dimensions: items concerning the social interaction characterized by mendacity and arrogance, items concerning the factor of deficient affective experience, and, finally a dimension concerning impulsivity and irresponsibility (Cooke and Michie 2001). However, the exact factorisation of psychopathy is an open issue amongst specialists (see Hare and Neumann 2006).

The PCL-R has played a central role in different types of fruitful research and there are good reasons for considering it a plausible unifying diagnostic tool. Statistical studies appear to show that it might be a useful predictive tool for recidivism (Douglas, Vincent, and Edens 2006). Moreover, the existence of functional deficits that are specific to psychopathy is corroborated empirically (Blair, Mitchell, and Blair 2005). Finally, recent brain activity visualization studies (positron emission tomography, computer assisted magnetic resonance) suggest that there might be specific anatomic and functional neurological anomalies underlying this disorder (Raine and Yang 2006).

3. Measuring Moral Understanding in the Psychopath

Several philosophical accounts of moral responsibility hold that moral understanding is a requirement for deeming an agent morally responsible.5 Without offering a complete characterization of moral understanding, here it is enough to point to a minimal necessary requirement for ascribing such an understanding. The upholders of the majority of views on the nature of moral concepts and judgment, and of the associated faculties, should agree that an agent possesses moral understanding when, minimally, he or she has the capacity to recognize that, when acting, he or she and other individuals should consider the interests of others. Moreover, it seems safe assuming that this recognition, whatever the subservient underlying faculties, can be reflected in the agents' ways of explicit reasoning about the permissibility of performing certain types of action in certain contexts.

Psychologists have devised experimental paradigms to establish the presence and nature of this type of reasoning in agents. Moreover, these paradigms have been applied to psychopaths. Thus, the investigation of the moral understanding of psychopaths can consider this type of experimental evidence. An important psychological paradigm for the investigation of moral understanding was developed by Elliot Turiel (Turiel 1983). This paradigm is based on the moral/conventional distinction task. The participant is presented with vignettes involving moral and conventional transgressions. An action is a moral transgression when it has consequences for the rights and welfare of other individuals such as hurting another individual or damaging his/her property. Conventional transgressions are defined by their consequences for the social order; these are actions such as talking in class, dressing in opposite-sex clothes. The participant has to make judgments about the transgressions. It has emerged that children of 4 years find acceptable transgressing in certain circumstances to conventional rule imposed by authorities (teachers, parents). However, they think that moral transgressions are always impermissible. For instance, they would judge these transgressions unacceptable even in cases where the authorities imposing moral rules are not present.

Recent empirical results suggest that adult psychopathic offenders, when compared to non psychopathic offenders, manifest insensitivity to the distinction between moral and conventional transgression (Blair 1995; Blair, Jones, Clark, and Smith 1995). Now it seems that an ordinary conception of moral understanding will require, at least, that an individual should be capable of distinguishing between conventional and moral transgressions. Therefore, the application of Turiel's paradigm to psychopaths appears to offer evidence for the conclusion that they fail to draw a distinction that is importantly related to moral understanding.

These empirical results, however, do not show that psychopaths are incapable of drawing the moral/conventional distinction and thus are incapable of moral understanding. This behaviour needs to be caused by certain impairments in order to be the expression of incapacity. Therefore, we should consider the available explanations for their failure to draw the moral/conventional distinction. Some philosophers have assumed that the performance of psychopaths in the conventional/moral task can be explained by deficits in the psychological faculties required for moral judgment.

4. The Moral Faculties Stalemate

The recent philosophical discussion on the moral understanding of psychopaths is characterized by polarized positions. This polarization occurs particularly around key notions such as moral judgment and its relationship to emotive and rational faculties. To illustrate this debate, I will consider first a rationalist approach offered by John Deigh (Deigh 1995).

Deigh has investigated the moral responsibility of psychopaths by using a rationalist model of moral judgment inspired by Kant. According to this account, the capacity for moral judgment presupposes that certain formal principles regulate practical reason. This requirement implies a number of conditions. Firstly, and more importantly, subjects should be able to recognize their actions as a manifestation of their intentions. Moreover, they should be able to universalize these intentions. Notoriously, opinions differ on how the criterion of universalisation should work to deliver moral understanding; however its theoretical aim is quite clear. This criterion is required to impose consistency in moral judgment and thought. In accordance with this principle, an individual possesses moral understanding when she recognizes as reasons for action rules that she wants to regulate the behaviour of those who are in a situation similar to hers.

According to Deigh, to know whether an intention could apply to all persons, a subject has to recognize that other individuals have interests and goals that they regard as good. However, he suggests that a form of understanding richer that this recognition is required for the right kind of universalisation. A subject might recognize that others have interests that they regard as important, but he might still assume that only his interests matter. Therefore, although he might see the interests of others from their point of view, he might universalize his intentions without being lead to recognize any inconsistency. Moreover, the capacity for moral understanding requires a form of empathy that renders the agent capable of imagining other people's feelings of frustration that might result from his actions and to understand that their interests constitute reasons for action, even if such reasons are different from his own.

Deigh suggests that this notion of empathy has to be quite “rich”. For example, empathy here cannot be taken as mere emotional identification. Children, for example, can empathize in this sense. Moreover, sadists arguably need at least this form of empathy to take pleasure from others' pain. Thus, Deigh argues that possessing moral understanding requires having some sort of mechanism for the comparison of values and goals of others with ours. Therefore moral understanding requires, firstly, appreciation of the fact that one's interests might conflict with those of others. Secondly, this understanding requires sensitivity to a criterion for the solution of these conflicts. It is in virtue of this “mature empathy” that rational constraints and principles of consistency enter as requirements for moral understanding.

Deigh's rather elaborate set of psychological requirements for moral understanding produces two main hypotheses about the shortcomings of the psychopath that need to be empirically investigated (Deigh 1995, p. 763). Firstly, the psychopath might be incapable, given a certain “stunted development”, of reaching a proper understanding of others' interests and reasons for action. Secondly, it could be the case that they revert to an egocentric perspective, because they cannot handle conflicting different perspectives, given that they do not appreciate the need for their harmonization. However, some might maintain that there are philosophical reasons for not investigating these hypotheses. This because Deigh fails to provide a satisfactory account of the faculties required for moral understanding.

Shaun Nichols, for instance, has argued that psychopaths undermine rationalist accounts of moral judgment and understanding (Nichols 2002). According to him, psychopaths, being rational individuals that fail to be motivated by moral reasons, offer a counterexample to those that assume that moral rationalism is a conceptual or empirical truth. Moreover, moral rationalism, understood as an empirical account of moral psychology, fails to explain the psychology of psychopaths. We can leave aside the important problem of the relevance of psychopaths for the meta-ethical issue of the nature of the capacities required for moral judgement. What is relevant here is that Nichols suggests an explanation of their failure to draw the distinction between conventional and moral norms that might shed light on the issue whether they are not capable to draw this distinction.

Nichols focuses on well-documented emotional impairments that affect psychopaths' empathic responding. Adults with psychopathy, and children with presumed precursors of psychopathic traits, show reduced autonomic responses to and recognition of fearful and sad behavioural manifestations (facial expression, vocal affect) (Blair 1999; Hare, Clark, Grann, and Thornton 2000). He, then, argues that an account of morality based on moral sentiments explains the case of psychopaths. Their immoral behaviour in general and their incapacity to draw the distinction between moral and conventional rules is explained by their emotional impairments that in turn affect their capacity for moral judgment and understanding.

However, empirical evidence concerning psychopaths suggests that their moral shortcomings can be explained by adopting a Kantian view which emphasizes the role of rationality in moral understanding. Firstly, it has been persuasively argued that highly-functioning autistic adults with Asperger's syndrome manifest a similar deficit in empathic understanding as psychopaths. However, individuals affected by this form of autism can realize, by reasoning, that other people have reason-giving interests as their own (Kennett 2002).

Moreover, given that without consistency in conception or consistency in willing, there cannot be universalisation, psychopaths manifest impairments in their rational capacities that appear to undermine their capacity to think consistent course of actions and will the means for their ends (see for this argument Maibom 2005). In particular, let us consider a subject that has a reason to form the intention to act in accordance with a certain universal rule. It seems that she should recognize that having that reason commits her either to pursue the means for that action or abandon it (see Millar 2004, pp. 76–78).

But it seems that psychopaths do not have this capacity. First of all, there is a growing literature attesting that psychopaths have attention deficits that cause problems when they have to coordinate their specific strategies (means) required to carry out a certain underlying intention (end). Moreover, psychopaths have problems with response reversal, the capacity to change responses that were previously rewarded and then punished (Newman and Kosson 1996). Clearly, this appears to be a limitation in their capacity to follow strategies that will consistently promote their ends.

Thus, it can be concluded that psychopaths, besides emotional impairments suffer cognitive limitations that impair, relatively to non-psychopathic individuals, their rational capacities. Therefore, it appears that both rationalists and sentimentalists can accommodate the case of psychopaths.

Walter Glannon (Glannon 1997) has advanced an important objection to this conclusion. He claims that emotions play a central role in motivation and rational deliberation on the basis of a well known hypothesis advanced by Antonio Damasio. Damasio studied patients who have suffered lesions of their frontal lobes and argued that emotions have a central role in guiding practical deliberation (Damasio 1994). The central idea here is that emotions play a role in limiting the space of possible options that a subject will consider when deliberating on the action to pursue. In fact, he argues that the representations of possible outcomes are associated, through experience, to a certain emotion (positive or negative), that Damasio calls a “somatic marker”. The occurrence of a certain representation of a future outcome will determine the occurrence of an emotive effect, either positive or negative, that will accordingly induce a positive or negative disposition in the subject in relation to the action that will bring about the outcome.

According to Damasio, certain lesions to the frontal lobes impair the formation of somatic markers. Thus, the patients so affected lack emotional responses to the events that will shape the space of alternative possibilities that are evaluated in their deliberation. For example, in the case of the patient known as Elliott, his prefrontal cortex was rendered dysfunctional owing to a tumour. Elliot's behaviour became extremely irrational. Consequently, his job was terminated, his marriage collapsed, and he lost his income. Moreover, it has been suggested that damage to somatic marker functioning early in development may impair the normal acquisition of moral knowledge. For instance, Damasio and his collaborators studied two patients who suffered ventromedial frontal lobe damage early in childhood (Anderson, Bechara, Damasio, and Damasio 1999). Both patients showed psychopathic features such as irresponsible and criminal behaviour, abusive behaviour towards others, and lack of empathy and remorse.

Glannon endorses the hypothesis advanced by Damasio and others that impairment in somatic marker generation might underlie psychopathy. However, even if we concede that Damasio's account is satisfactory for patients with damaged frontal lobes, we cannot extend it to psychopaths. It is true that there is some preliminary evidence, based on the use of the Four-Pack Gambling task, that suggests that psychopaths manifest an abnormal somatic marker functioning (Blair, Colledge, and Mitchell 2001). However, these results are not uncontroversial. In two other studies emerged that psychopathic individuals perform similarly to controls on the Four-Pack Gambling task (Blair and Cipolotti 2000, Schmitt, Brinkley, and Newman 1999). Moreover, there are studies that appear to show that those who score highly in the PCL-R respond to emotive stimuli that are not involved in causing sadness or fear (Flor, Birbaumer, Hermann, Ziegler, and Patrick 2002). These individuals show autonomic arousal to emotionally arousing stimuli so long as these stimuli are not expressions of sadness or fear. But according to Damasio's model, lesions in the system of somatic markers cause a complete exclusion of whatever the relevant emotional response. It could be replied, of course, that in the case of psychopaths, we might hypothesize that they suffer more localized impairments that undermine their emotive responses. However, this hypothesis is not only hostage to empirical data that we lack at the moment, it is also theoretically implausible. In fact, there are sound reasons to think that psychopaths manifest the opposite impairments of those that would follow from a damaged somatic marker system.

Finally, Heidi Maibom has suggested that these results contrast with the impairments of patients with damages to the frontal lobes (Maibom 2005). Some studies offer compelling reasons for concluding that psychopaths manifest attention deficits (Jutai, Hare, and Connolly 1983). For example, empirical studies appear to indicate that psychopaths dedicate a great deal of their attention resources to events of immediate interest, while they ignore effectively other stimuli. In a well replicated study, it has been found that psychopaths show a reduced physiological response to irrelevant auditory stimuli when they are engaged in some other activity, although their response is normal when they are involved in passive listening. Similarly, it has been shown that psychopaths are not distracted by certain stimuli when they perform certain tasks (Hiatt, Schmitt, and Newman 2004). In these tests they should perform certain duals tasks, were they were required to follow the movements of several objects. These findings suggest that the problem with psychopaths is that they have an excessive narrowing of their attention. But this is the opposite of what would be expected if psychopaths had their somatic marker system damaged.

Thus, although there might be a significant relation between emotions and reason, Glannon has not put forward compelling evidence for the idea that the practical irrationality of the psychopaths depends on their emotional impairments. It seems that psychopaths have impairments that undermine both emotional and rational capacities. Therefore, it is far from clear how their deficits contribute to the understanding of faculties required for moral understanding.

It seems that both sentimentalist and rationalist accounts of moral understanding can provide explanations of the deficits of the psychopaths that might undermine their performance in the conventional/moral distinction task. Deciding which of these two explanations is the correct one requires an independent investigation to establish which of these two approaches to moral understanding is correct. So without these independent accounts, there is no hope of establishing whether psychopaths are unable to recognize moral norms because of some impairment of what classically philosophers have taken to be the moral faculties.

However, given the practical and pressing nature of the question of the social response to psychopaths, this appears to be an interesting and important result. It authorizes us to discuss this practical concern in terms of “middle ground principles” and “parity of explanations” between competing important philosophical views, whose final adjudication does not appear to be forthcoming or easy. The majority of sentimentalists and rationalists can agree that moral understating requires the capacity to draw the distinction between moral and conventional norms. Moreover, the empirical evidence so far considered appears to support the conclusion that both these theories can explain psychopathic deviant behaviour in terms of impairments of capacities required for moral understanding. Nevertheless, it is clear that this does not lead to an uncontroversial outcome concerning the moral responsibility of psychopaths.

First of all, sentimentalism and rationalism as sketched here might not represent all the plausible positions on moral understanding.6 Moreover, even if we accept this disjunction as exhaustive, further steps might be required to establish that psychopaths are not morally responsible. Even if we can establish that psychopaths are incapable of moral understanding, because these faculties are impaired, we will still have to investigate whether these impairment are such to undermine their moral responsibility.

There are several problems to be considered, here I can only mention one that derives from interfacing our practices of ascribing moral responsibility and the empirical data discussed. The empirical results show certain functional impairments of the psychopaths as traced by statistical differences with individuals diagnosed as not being psychopaths. Thus, without a deterministic explanation of the impairment that generated these functional impairments, we have to be prepared to adjust our judgment concerning the presence of absence of a certain capacity in a certain class of individuals in a statistical fashion. In turn, this will imply that our practice to ascribe moral responsibility to certain classes of individuals, depending on their moral understanding, has to be sensitive to these statistical correlations.

5. Conclusion

It appears that the empirical evidence we have about psychopaths is consistent both with the idea that they might lack certain emotional capacities and certain rational capacities that are required for comprehending the distinction between moral and conventional rules. Thus, it is clear that psychopaths do not draw an important distinction between conventional and moral rules. Now, both two principal theories of moral understanding imply that their performances in this respect derive by impairments in certain moral faculties. Investigating whether and how these impairments undermine psychopaths' moral responsibility has to be left for another occasion.

Acknowledgments

I would like to thank John McMillan, Suzanne Uniacke, Heidi Maibom, and Tony Ward for their helpful comments on previous versions of this paper. Moreover, parts and antecedents of this paper were presented at the 18th Annual Meeting of the AAPP (Toronto), at the Institute of Psychiatry at King's College (London) and at philosophy departments in Siena, Hull, Rijeka, Zagreb, and Firenze. I am grateful to the audiences for very helpful discussions.

Footnotes

*

This work was supported by the Wellcome Trust [grant number 075966/Z/04/Z], that financed my Postdoctoral Research Fellowship at the Institute of Applied Ethics of the University of Hull.

1

For a more articulated defence of this formulation of the problem see Malatesti and Mc-Millan forthcoming.

3

It is important to stress here that, given that the diagnostic criteria are significantly different, investigating the moral responsibility of psychopaths might not shed light on anti-social personality disorder in general. However, while the majority of individuals with ASPD are not psychopathic, those that fall under the psychopathic diagnosis meet the diagnostic criteria for ASPD, see Ogloff, 2007.

4

This cut-off value is usually adopted in North America; in Europe a value of 25 is often used.

5

See, for instance, Fisher and Ravizza 1998, pp. 69–73 and Watson 1993, pp. 126–128. Moreover, see note 1 above for discussions that use this assumption to investigate the moral responsibility of psychopaths. However, some authors have denied the relevance of moral understanding (or moral knowledge) for moral responsibility; see Arpaly 2006 and Scanlon 1998. Particularly, Greenspan 2003 offers an application of this insight to the case of psychopaths. Convincing replies to these deflations of moral understanding are offered in Levy 2008, pp. 132–135.

6

For instance, there are Aristotelian alternatives. Moreover, sentimentalism and rationalism can take different forms.

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