Does every human being have a conscience? Are some people simply unable to engage in moral deliberation?
Plato’s Alcibiades, Shakespeare’s Iago, and Hollywood’s Hannibal Lecter have become stereotypes of the amoral: individuals whose callous disregard for the wellbeing of others seems almost a caricature of a real human being. Yet increasing evidence suggests that a small fraction of human beings are, in fact, morally incapacitated. From an early age, nothing restrains them from engaging in deceit, manipulation, and violence.
These conscience-free individuals first came to the attention of psychologists studying hardened criminals, but it’s become increasingly apparent that many—perhaps most—remain in society. And they extract a toll of conflict and suffering disproportionate to their numbers. Only now are psychologists beginning to realize who they are and how they operate. By considering what happens to people when a moral conscience is lacking, we may better appreciate just how our conscience makes us human.
The Conscience as an Awakening
The development of the human personality may be seen as a progressive awakening to ourselves, to others, and to the world. In most cases, we first begin to experience this process within the intimacy of a family. Within a family, we first learn if and why we are valued. We learn to value others—or not to. We learn to act within the bounds of an external authority, which can present itself to us as benevolent and just, indifferent and passive, or threatening and arbitrary.
As we acquire our sense of self and learn to relate to others, we acquire the capacity to understand and share the feelings of another person, particularly when they suffer or are in some way distressed. Researchers have demonstrated evidence of empathic responses in children as young as age one.
Over time, we learn to classify actions as morally “good” or “bad.” Learning to “do good” and “avoid evil” happens in many ways: by immediately witnessing the actions of others (example); by reading, viewing or hearing the accounts of actual or fictional events (literature); even by simple explanation of moral values (instruction). We populate our psyches with content drawn from these experiences. This learning process leads to the development of what some have called a “moral imagination”: a store of past experiences from which an individual may draw in attempting to resolve concrete moral dilemmas.
As our capacity for moral reasoning develops, we become aware of an internal witness to our actions, which passes judgment on our thoughts, words, and deeds, nudging us toward the good. A refined conscience is one that struggles sincerely and carefully to discern and do what is good and avoid evil whatever the cost. It fosters a heightened sensitivity to the welfare of others. It leads us to take responsibility for our actions.
What Happens When Conscience Doesn't Develop?
In some people, however, this moral awakening never takes place. In 1939, Scottish psychiatrist David Henderson published a book called Psychopathic States describing patterns of extreme egocentric behaviors in otherwise sane, rational individuals. These people stood out because, at the time, most criminals were believed to be either “imbeciles,” “insane,” or both. Two years later, US psychiatrist Hervey Cleckley published the first edition of The Mask of Sanity, a series of character portraits of individuals who were cunning, heartless liars acting without any ethical restraint. They weren’t crazy. They simply had no inner sense of right and wrong.
Before Henderson and Cleckley, few in the psychiatric establishment had conceived of a sane, intelligent person repeatedly committing vicious, often violent crimes without hesitation or remorse. Their work served as the basis for a modern understanding of the psychopathic personality.
In the 1980’s, Canadian psychologist Robert Hare began a lifelong project to define scientifically rigorous diagnostic criteria for psychopathy based on structured interviews and analysis of the lives of hardened criminals. His subjects were identified based on the list of traits described by Cleckley. He and his graduate students at the University of British Columbia developed what is today known as the “Psychopathy Check List—Revised”. It has become the standard diagnostic test for psychopathy. According to Dr. Hare, psychopaths are
social predators who charm, manipulate and ruthlessly plow their way through life, leaving behind a broad trail of broken hearts, shattered expectations and empty wallets. Completely lacking in conscience and in feelings for others, they selfishly take what they want, do as they please, violating social norms and expectations without the slightest sense of guilt or regret.
When the Hare test is given to normal control subjects, most score a one or two on a scale of forty. Most general population inmates score about twenty or twenty-one. Psychopaths, by definition, score thirty or higher. Among incarcerated criminals in the US, about 20 percent fulfill the Hare diagnostic criteria for psychopathy. But this relatively small fraction accounts for at least 50 percent of all violent crime in the United States. They are also much more likely to re-offend, with recidivism rates of about 80 percent.
Most psychopathic individuals have experienced a traumatic and dysfunctional childhood. Data supporting the inheritance of predisposing genetic factors has been offered as well. Many have specific, reproducible anatomical defects identified by functional MRI. When individuals with psychopathic PCL-R scores are evaluated by functional MRI, characteristic patterns of abnormalities have been described. The brains of psychopaths are markedly deficient in neural areas critical for three aspects of moral judgment: they are unable to recognize situations as “moral”; they are unable to reach a decision about a moral issue; and they are unable to suppress a response pending the resolution of a moral dilemma.
Given the reproducible correlation between clinical diagnostic criteria and neuroanatomical abnormalities, some have proposed classifying psychopathy as a distinct illness. For now, the psychiatric establishment classifies psychopathy as a type of antisocial personality disorder. The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual on Mental Disorders (DSM-V) defines anti-social personality disorder as “a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”
The word “pervasive” implies that every aspect of such a person’s personality is committed to this type of behavior. And, by definition, psychopathic behavior patterns emerge before age fifteen. These are individuals consumed by the desire to possess and dominate by any means at their disposal. The following video clip is a case in point: a young man with a violent criminal history describes his behavior. The complete video is very disturbing and should be viewed with discretion.
In their interpersonal relations, psychopaths are charming manipulators, incapable of attachment to others. They exhibit a callous disregard for the wellbeing of others. For them, lying is habitual and automatic. With their lies, they define their own reality in order to maintain some control of their surroundings. Relationships are just opportunities for manipulation and control. Other people are dehumanized and valued only as possessions. Psychopaths are stimulated by exerting control over others. Sometimes they live a nomadic life, moving from place to place to live for a time off the people they’ve charmed until they get bored and move on to their next victim. They completely lack empathy.
Their ability to feel and express emotion is absent or, at best, shallow. They are rarely anxious. They feel no remorse or guilt. If they do exhibit an emotion, it is a “show,” the “mime” of a reaction they have observed in others. It is a deception intended to facilitate their manipulation of others. While intelligent and rational, they are unable to identify any reason to restrain themselves from committing a crime or hurting others. They easily—even eagerly—violate social norms.
They don’t take criticism well and often retaliate against their critic. If confronted with the harm they have inflicted, they aim to portray themselves as the victim. They never acknowledge responsibility for their actions and are insensitive to punishment. Some investigators have postulated that they experience an intense, chronic anger; but their anger is cold, without any emotional arousal. It may be of interest here to consider that Aquinas understood anger as a form of sorrow.
Some of these traits are apparent in this clip of Richard Kuklinski, a man convicted of multiple contract murders in the greater New York City area and who confessed to hundreds more. While committing his crimes over decades, he lived a superficially ordinary life — punctuated by episodes of domestic violence—with a wife and three children in suburban New Jersey. After describing his crimes in detail over several hours, the interviewer offers to turn the tables, and asks Kuklinski if he wants to ask him a question. Kuklinski asks him, “What do you think of me?"
Given the fact that Kuklinski’s life had been given over to murder, deceit, and all forms of violence, his references to “love,” “caring,” and “friendship” may be attempts to manipulate the interviewer.
Not All Psychopaths Are Criminals
Yet not all psychopaths are violent criminals. Research suggests that about 2 percent of males and perhaps 0.5 percent of females in the United States are psychopaths by Hare’s criteria, making it likely that most psychopaths are never convicted of crimes. Assuming a total US population of 325 million, then there would be about 3.8 million psychopaths in the population, or about 3 million males and 785,000 females. These people live in our society. They may rise to influential positions in large corporations, government, academic institutions, hospitals, and church organizations. Like their criminal counterparts, they don’t feel bad when they do bad things. They might be recognized as strategic thinkers who plot their personal advancement at the expense of others, enjoying the pain they inflict.
Psychologists Paul Babiak and Robert Hare have summarized the research regarding these “industrial” or “corporate” psychopaths in the book Snakes in Suits. The book reviews how psychopaths manipulate their way toward promotions, the effects of their presence on the work environment, and the superficial similarities and substantial differences between leadership skills and psychopathic traits. Based on early data using the Hare psychopathy test, they found that around 3 percent of 203 corporate professionals selected by their companies for management development programs fulfilled criteria for psychopathy. These authors are developing a clinical test of psychopathy designed for the workplace.
We can easily identify likely psychopathic personalities in recent history: the tyrants of twentieth-century Europe and Asia, government leaders of North Korea and Cuba, those responsible for the global financial crisis, and so on. A very small number of ill-intentioned individuals can generate immense suffering and turmoil.
At a more personal level, however, what do psychopathic behaviors tell us about the conscience? To lack a conscience means:
- To consciously misrepresent our intentions toward others;
- To manipulate others for the sake of domination and control;
- To mask our selfish intentions by apparently altruistic actions;
- To divide others into pawns, patrons or patsies based on their utility;
- To find satisfaction in the turmoil we cause;
- To lack the experience of the range of emotions that animate a human life;
- To deny responsibility for our actions;
- To see our self as the only thing that matters.
To have a conscience means:
- To recognize the evil in every human heart beginning with our own;
- To seek a better way of living;
- To recognize the healing value of remorse;
- To value empathy and compassion toward the suffering of others;
- To take responsibility for our actions;
- To take responsibility for the wellbeing of others.
Just as evil may be understood as the absence of good, darkness as the absence of light, cold as the absence of heat, the absence of conscience presents itself as profoundly dehumanizing and destructive. How these human beings have become so callous and self-centered remains a mystery. No treatment seems to help, and many express the conviction—mistaken, perhaps—that they are unable to change their behavior.
What is clear is that fostering the development of a refined moral conscience—for example, through stable family life, literature, and artful explanation—should be a priority for both individual parents and for society as a whole.
Jose A. Bufill, MD, FACP is a medical oncologist practicing in South Bend, Indiana. A version of this paper was given as an oral presentation on November 10, 2017 at the Eighteenth Annual Fall Conference of the Notre Dame Center for Ethics and Culture. His opinion articles on bioethics have appeared in the Chicago Tribune, USA Today, the Philadelphia Inquirer, and other media.