Content Warning: The following interview contains ableist language, including discussion of terms used in the work of the interviewee.

Scott O. Lilienfeld, Samuel Candler Dobbs professor of psychology at Emory University, will be presenting his talk “Beneath the Mask: The Search for the Successful Psychopath” next Friday. Lilienfeld researches personality disorders and specializes in psychopathy. He spoke with the Review via phone to discuss manifestations, common misconceptions and causes of psychopathy.

How did you become interested in studying psychopaths?

Well, I am one, so — just kidding. But I do get that a lot…

It was really by happenstance. I took an undergraduate course with Bob Dworkin at Cornell University. Bob taught a course on research in psychopathology and Bob, in that course, presented us with, for about a month or so, research on psychopathic personality. And I found it fascinating — really, really interesting — in part, because I’ve always been really puzzled by how people could grow up or develop without really some filter or empathy. In the course that Bob taught, he talked about the work of David Lykken and [how he] launched the experimental research on psychopathy and devised some very clever — I thought at that time — incredibly clever, ingenious methodologies that seem to show that psychopaths are deficient in fear and that that fear deficit may give rise to the core features of the disorder.

A couple of years later I applied to graduate school and got into the University of Minnesota, which was my first choice. After I got in, ironically, I was checking the faculty members who were actually not in the psychology department, but were adjunct to that department, and there was a faculty member in psychiatry and I noticed his name — David Lykken. I said, “Wow, that seems familiar. Is that the same [person] that did that interesting work that I found fascinating about psychopaths?” Sure enough, it was, so soon after I got to Minnesota I decided to meet David Lykken, and we met, and I asked to be in his lab, and he said yes. The more I worked for David, the more interested in the disorder I became, and the rest is history.

Psychopaths are often portrayed in pop culture. What are some popular misconceptions?

I think … some people confuse psychopaths with people who are psychotic and that might be because the names are sort of familiar. So that’s one misconception: that they’re out of touch with reality, they don’t know the difference between right and wrong. In fact, if anything, the opposite is true. Psychopaths probably do know the difference between right and wrong; they just don’t care. They understand that robbing a bank is wrong, typically, but they don’t seem to appreciate the moral gravity of the act.

Another common misconception is that psychopathy is equivalent or close to equivalent with violence, so that most psychopaths are very violent. It is true that psychopathy is tied to an increased risk for violence, but it’s also true that most psychopaths are not necessarily physically violent, although they can wreak havoc in many different domains.

Are there any differences, in terms of symptoms or neurology, between sociopaths and psychopaths?

Sociopath is really not a formal term anymore. We discourage people from using it because it means three or four different things.

So it’s more a popular term, and it’s not really a formal term. So the answer to that is probably no, because it’s not really a disorder itself. The term ‘sociopath’ actually came from the 1930s when some people thought that there was a difference between people with antisocial and criminal behaviors. [The behaviors that] stemmed from primarily genetic causes [were] only psychopaths, and those whose antisocial and criminal behaviors stemmed from more social causes, like bad parenting or growing up in a bad neighborhood or things like that, were sometimes called sociopaths. There has been some [push] to revise that distinction, but it’s not really stuck.

Are people born psychopaths, then? Are there any genes that predispose people towards psychopathy or is that unknown?

No one is really born a psychopath, I would think. We’re still trying to figure it out, but it’s undoubtably due to a very complex combination or maybe configuration of genes that mark it. At most, genes may predispose people to psychopathy. So there are probably some predisposing factors. We don’t quite know what they are, but there seems to be some genetic basis to some genetic aspects of the disorder, which include lack of fear and callousness, for example, that may in turn, when combined with environmental factors, give rise to psychopathy.

Of course there’s lots and lots [of] fearless people who are not psychopaths. Chris Kyle, the great American sniper, was a pretty fearless guy who doesn’t strike me as psychopathic. Lack of fear is not going to make someone a psychopath, but when combined with other traits and maybe then pairing with other environmental circumstances, [it] might further the predisposed people in that direction.

The topic of your talk is “The Search for the Successful Psychopath.” Can psychopaths be successfully assimilated into society? There’s the common belief that people that are in high-powered positions often have psychopathic tendencies.

That’s right, yeah. Well, we don’t know. … There’s certainly a lot of speculation that, at least in the short run, maybe these folks are out in society and, maybe, just maybe, leading corporations and winning political elections and so on, but a lot of that is really clinical lore, and there’s very little systematic research on the subject.

Some of your research also looks into self-reporting of psychopathic tendencies. How is psychopathy often diagnosed?

The most common method in at least research settings is something called the psychopathy check list. … It’s a very standardized interview. We ask the person about their personality traits and their behavior, but you also integrate that with cooperative information, ideally file information, to try to verify or confirm or in some cases disconfirm what the person had said. … And that’s not necessarily a well-supported way of doing it. We actually use self-report measures in our lab, which is somewhat controversial, but it has actually worked fairly well for us in our lab. But that’s publicly researched settings. We wouldn’t advise using self-report measures in forensic settings where people might have a strong motivation to [appear] good, for example.

Why is it controversial to use self-report methods?

Well, a lot of people think that, maybe with some justification, that because psychopaths tend to lie a lot and maybe not have much insight into themselves, that asking them about their own traits may not work. If [someone is] already a liar, asking them if they lie a lot is maybe not a good way of doing things. But what we do in our lab — we don’t ask them to reflect much on who they are. The [questions] don’t require much insight and don’t require much ability to reflect on one’s behavior or to evaluate whether one is psychopathic. We merely ask people what they do, what they’ve done and what their attitudes are. That seems to work pretty well.

The term “psychopath” is sometimes considered a slur. Do you have any the thoughts on the use of the term or possible alternatives?

It can indeed be a derogatory term. In our own lab, we prefer to talk about individuals with varying levels of psychopathic traits rather than psychopaths or non-psychopaths. Plus, this fits better with the research literature, which suggests that psychopathy is distributed along one or more dimensions rather than a black-and-white category.