The Psychopathology of Psychopaths [Mad, bad or adapted?]

The objective of my paper is to present a psychopathological conception of psychopathy and compare it with the mainstream nosographic diagnosis (antisocial personality disorder in DSM-5 and the design of psychopathy according to the PCL-R). This theoretical essay is informed by clinical situations involving psychopaths who were interviewed in prison or in forensic centres. The method applied a phenomenological psychopathology analysis to the clinical material. I first compare Binswanger’s conception of mania with psychopathic functioning. Patients’ behaviour is similar but the difference relates to the dialectic between the ego and the alter ego. A patient with mania has a fundamental crisis of the ego, which a psychopath does not have. A second finding concerns emotions and the adaptive dimension of psychopathy. An epistemological discussion of the concept of emotions reveals that psychopaths are competent at managing emotional stimuli, which confers a psychological advantage upon them. Finally, a reflection on empathy and sympathy clarifies the presentation of “psychopathic being-in-the-world”. Starting with the tension between clinical practice and critique of the dominant diagnostic scales, we can consider that the “essential characteristics” of the psychopathic disorder are reification of the alter ego without presenting an ego-related disorder, the adaptive benefits of emotional coldness, and empathic skills without sympathy.