It’s hard to believe that I haven’t covered this topic in over 500 posts up to the point.  It is a question that I receive from time to time and a question that many neurotypicals have staunch opinions on.  Is psychopathy a mental illness, or is it – as some would say – merely a defect in personality or character?  To answer this we must consider the types of mental illness as well as the role neurology plays in personality.  I hope that it is clear to the reader that the answer to this question should be ‘yes.’

Consider depression.  Depression can be organic – that is, caused by neurotransmitter imbalances in the brain – or environmental.  We do not make a distinction between these types of depression except via the approach we can treat them.  For the organically depressed, psychotropics are often panacea.  For the environmentally depressed, psychotherapy is often the cure.  We don’t call one type of depression “real” and the other “fake” – at least I hope not.  That is, we treat conditions born of neurology and of environment the same … except when we don’t.

Psychopathy has well-proven neurological roots.  The structures governing impulsivity, aggression, and empathy (among other areas) behave differently in psychopaths than neurotypicals.  Hell, they even are different than those found in “vanilla” ASPD individuals.  I leave the proof of this up to the reader – check the books The Psychopath Inside and The Psychopath Whisperer for further information.  However, it is also known that psychopathy (which ignores etiology) can arise from environmental factors including a troublesome childhood or forms of abuse.  How can something be a character defect (implying choice) if it is hardwired?  If we take the approach that we did in our treatment of depression, we would easily conclude that psychopathy is a mental illness regardless of its origin.  I should note that I believe this holds regardless of whether the afflicted believe themselves unwell or not.  Objectively, most psychopaths suffer some drawback due to the condition even if it may not be constant in nature.

Is psychopathy a mental illness?  Absolutely.  Those that believe otherwise are merely subscribing to theories that dehumanize the psychopath.  By painting a picture of choice, they put the onus on the psychopath to prove that they are not defective.  We psychopaths certainly have choice in our actions, but I am not so convinced that we have choice in our proclivities.  Either way, we should reject the notion that psychopathy is a mere defect in personality or character.  It goes much deeper.