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Can psychopaths be cured?

Dexter, one of the most famous psychopaths on TV.
Dexter, one of the most famous psychopaths on TV.

Psychopaths possess a combination of charm and emotionlessness that makes them capable of ruthless, impulsive, and even criminal acts. And, for a long time, psychologists believed that these people were simply incapable of experiencing emotion — and that there was no way to change that.

But now, emerging research is showing that this might not be the full story. There’s evidence that psychopaths might have more of a cognitive-processing problem — that they have difficulty paying attention to more than one thing at a time — than an emotional problem. So they focus tightly on a goal (say, stealing money) and lose the contextual information around it (it will make the victim feel sad, it's socially unacceptable, and it could lead to arrest).

If this is the case, then it might be possible to rewire psychopaths' brains to be less psychopathic. And that's what Arielle Baskin-Sommers and her colleagues are trying to do with a group of specially designed computer games. "The hope is you're training those neural pathways that will help them self-regulate better and not take advantage of people," she says.

In a paper recently published in Clinical Psychological Science, Baskin-Sommers showed that six hours of computer-game training caused measurable improvement in psychopaths' cognitive functioning. (These particular psychopathic individuals were inmates at a correctional facility.) Although the researchers don’t yet know if this will translate to better behavior in the real world, Baskin-Sommers says she’s "cautiously optimistic" that they’ll be able to really help psychopaths in the long run.

I talked to Baskin-Sommers, a clinical psychologist at Yale, about what makes people psychopathic and how they can be helped.

Susannah Locke: What percentage of criminals are psychopaths?

Arielle Baskin-Sommers: It’s about 15 to 25 percent, depending on various estimates, and about 1 percent of the general population. Psychopaths account for some of the highest rates of recidivism of all offenders. This pretty severe group of individuals accounts for a huge cost to our society — not only in terms of criminal offending and substance abuse, but also, there’s such a burden to the offender and their family.

SL: So why do psychopaths act like they do?

AB: There’s a big debate in the field of psychopathy. Some believe they’re incapable of experiencing emotions.

But, also, they do a bad job of processing contextual information. And they have a really hard time doing multiple things at once. There’s an attention bottleneck that essentially has the psychopath narrow the focus of their attention on something that’s their goal. For psychopaths, there are certain brain regions that tend to be overactive, which tend to inhibit their emotion regions.

If you believe that they're incapable of experiencing emotions, then there’s nothing you can do to help them. But if you take this other view, then there’s hope.

SL: Are there currently treatments for psychopaths?

AB: So unfortunately, right now treatment isn’t as effective as it could be for these types of individuals. They generally start off worse than a lot of offenders. This is an extreme offender in a lot of ways. And they don't seem to show as much improvement as other offenders. They may even get a little better at being psychopaths in treatment ([although] that evidence is pretty limited).

SL: Some of the psychopaths in your study were in a comparison group where they got general training on self-control. But others had training designed specifically for psychopathy. What was that like?

AB: This is really the first deficit-matched training protocol for offenders, in general. There were three computer games that they played. All of them had them figure out how to integrate contextual information. One had an elephant and a giraffe. For a while, the elephant was winning you points, and then it switched without warning [so the giraffe was winning you points]. It’s tapping your ability to notice rule changes in your environment and adapt.

Another task had [participants] tell me, on a face, if the eyes were looking left or right by pressing buttons for left or right — except if it was a fearful face, it would actually switch it. You would have to not only focus on your goal, but notice the emotion on the face.

SL: Psychopaths not only improved at these specific computer games, but also become more normative in a whole battery of other tests, including tests related to emotions and a modified stroop test. Is that a big deal?

AB: That was a big step for cognitive remediation. They not only improved on the task; we’re seeing generalizability of the skills that they were learning.

SL: How much did the psychopaths improve?

AB: The effects varied. Generally they were on the smaller side, but that’s actually pretty common in treatment-type research. It definitely suggests there’s more work to be done in how to make these effects stronger. It might be more training, or combining with existing treatments. There are lots of exciting possibilities. This is certainly the first time anything like this has been done.

SL: Do you know if this treatment causes better behavior in the real world?

AB: That’s the biggest question. We know that we can change processes in the lab right now, but we don't know about when they’re released. With the group that has already completed the training, we are beginning to go through their Department of Correction files — things like toxicology reports, and whether they were rearrested. Our hope is to do the training on a larger scale and also follow up in a more planned way.

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