Psychopathy: A “Mysterious” Disorder

Much of science begins with a mystery: An observation about the world that resists easy explanation. Psychopathy research is no exception. From its very origins, it has been animated by a recurring puzzle: Why do some people, often intelligent and outwardly well-adjusted, act in careless ways that violate social norms and laws without the slightest sense of remorse?

Today, I’m no longer convinced that there’s much of a mystery here. But it seems that most people who are interested in psychopathy are puzzled by this observation. And so was I when I was first drawn into this world, after reading Robert Hare’s best-selling book Without Conscience.

The earliest articulation of this mystery in scientific literature can be traced back to 1786, when American physician Benjamin Rush (also the co-signer of the Declaration of Independence) gave a speech describing a man named Servin. Rush portrays him as a paradox—a prodigy of knowledge and vice. Servin was fluent in Greek and Hebrew, socially likeable, and intellectually sophisticated. But alongside this brilliance was a deeply unsettling character:

“Treacherous, cruel, cowardly, deceitful, a liar, a cheat, a drunkard and a glutton... a blasphemer, an atheist.”

In short, Rush said, “in him might be found all vices that are contrary to nature.”

What perplexed Rush was not just Servin’s moral corruption, but the mismatch between his cognitive sophistication and his apparent moral blindness. Rush believed that people like Servin suffered from a fundamental inability to distinguish right from wrong, speculating that it must be some form of cognitive defect that left them incapable of genuine socialization. Rush initially called the condition “anomia,” and later “moral derangement,” but his work was one of the earliest formulations of what would later be called psychopathy, a change that occurred in the early 1900s.

With Rush, and those who followed in his intellectual footsteps, the mystery became a subject of continuous fascination. And so today we have an entire scientific field preoccupied with this very phenomenon: A person with no obvious cognitive deficits, yet seemingly incapable of moral and social functioning.

Perhaps the most influential modern theorist of psychopathy was Hervey Cleckley, an American psychiatrist from the state of Georgia, writing in the mid-20th century. Cleckley proposed (much along the lines of Rush) that what is “wrong” with psychopathic persons is that they are emotionally barren—incapable of generating deep or lasting feelings. For Cleckley (who seemed inspired by moral sentimentalists like Adam Smith and David Hume), emotions were the bedrock of human value systems. If a person cannot feel emotion in any deep or sustained way, how could they possibly develop values? Or care about violating values they feel nothing for?

Cleckley famously described this condition using a captivating metaphor: The Mask of Sanity (also the title of his seminal book). The psychopathic person wears a mask that mimics normality—charming, articulate, etc.—but behind the mask, Cleckley argued, there is only a hollow core. A barren psychological landscape. No emotional resonance, no moral depth. Just a performance.

This metaphor has endured in both clinical literature and popular culture. In fact, one of the most iconic pop-cultural references to psychopathy—Patrick Bateman, the protagonist in American Psycho—seems to draw directly from Cleckley’s work. In a now-famous scene from the 2000 film adaptation, Bateman describes his morning routine with mechanical precision while peeling off a translucent facial gel mask. As he does, he narrates in a dull, but oddly chilling monotone:

“There is an idea of a Patrick Bateman, some kind of abstraction, but there is no real me, only an entity, something illusory, and though I can hide my cold gaze and you can shake my hand and feel flesh gripping yours and maybe you can even sense our lifestyles are probably comparable: I simply am not there..”

Link: https://www.youtube.com/watch?v=RjKNbfA64EE

The scene is a visual echo of Cleckley’s metaphor: Beneath the polished exterior, there is emotional emptiness.

But despite the scene’s artistic appeal, most researchers today would caution against taking American Psycho too seriously as a depiction of psychopathy. Bateman is delusional, hallucinatory, and likely meant to represent a broader caricature of “madness” that has little to do with reality. The story is, after all, fictionalized to the point of satire, and in many ways, it distorts rather than illuminates the concept of psychopathy.

Still, the mystery persists. Why do some people behave in ways that seem so profoundly alien to most of us, such as violating social norms and moral values without the slightest sense of remorse?

To me, these questions have never gone away. But I think about them differently today. Psychopathy Unmasked is partially an attempt to explain how.

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This blog is part of the series “The Making of Psychopathy Unmasked,” which shares behind-the-scenes stories about how the book came together and the experiences that shaped my thinking on psychopathy.