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I’ve been working in forensic mental health, that is the system that manages men and women who commit a crime that is deemed to be a consequence of their mental disorder, for about fifteen years now. Most of that time has been doing research and clinical work in hospitals and prisons for people who would meet the criteria to be described as a psychopath.

Three years ago, I made a fateful decision to advise a group of then fairly unknown writers and TV producers in creating a TV series about a psychopathic female assassin. Sound familiar? This was, of course Killing Eve: the runaway BBC America hit that made me realise that you can make even a clinically accurate psychopath into a compelling character (no thanks to me).

From ‘Killing Eve’ Twitter

But I’ll let you into a secret: I find psychopaths pretty boring.

That might be an odd thing to say for someone in my position. That doesn’t mean it’s not true, however; and I’m not sure it’s such a bad thing. Let me explain.

I came into studying psychopaths by accident. I didn’t pick up a copy of American Psycho one day and suddenly decide that Patrick Bateman’s misogynistic, misanthropic violence was the key to understanding other people; I just needed a job.

So when my research proposal involving work with people with severe personality disorder in high-security conditions was accepted, psychopaths were part of the deal. And reader, I met them: many, many of them throughout the next fifteen years.

When I started out on my career, I came into England’s maximum Rampton Hospital in the early 2000’s with the full expectation (even hope) of meeting Hannibal Lecter’s English equivalent. Someone intelligent and articulate, for whom psychopathy was simply a disorder of empathy: the inability to give a damn about other people. I expected skilled manipulation, games within games against which I would need all of my wits, like Jodie Foster’s endlessly resourceful Agent Starling, just to survive.

However, the grim reality is that the vast majority of psychopaths (and I mean that in the strict sense of people with a score of 30+ on the ‘Psychopath test’, aka Robert Hare’s PCL-R) are… well, in my experience, pretty dull.

Yes, their criminal history might have some morbidly salacious details, but in person… let’s say the durability of the Lecter archetype is definitely a testimony to Thomas Harris’s skills as a character writer than to any underlying reality. Criminal psychopaths, far from being charismatic geniuses, are — as one antagonist describes Killing Eve’s Villanelle — “a void”.

Not just a void of empathy, but a void of personality, of substance.

Research has shown that criminal psychopaths are less intelligent than the general population, they have little in the way of life experience and tend to dislike telling the truth, preferring stories that cast them in a positive light.

Since, even in the era of fake news, a lot of us do still quite like hearing truthful stories, even slightly embellished ones, this can make interactions with criminal psychopaths seem tiring, repetitive and honestly, tedious.

It might well be exciting to meet a psychopathic career criminal once in your life — and it was for me, the first time — but after the fifth or sixth variant of ‘it wasn’t me, guv’ or ‘[my victim] were asking for it’, any sense of excitement has ebbed.

And since the nature of their neurological dysfunction means that psychopaths lack impulse control and are primarily concerned with satisfying their own desires, interacting with one in any environment is a risky business.


However, the relatively shallow charms of the criminal psychopath in prison are nothing next to the nonsense surrounding the “psychopath industry”.

“Psychopaths live among us”, we are told, by someone who should know.

Are you in a relationship with a psychopath without knowing it”, we need to consider, as if a pattern of pathological lying and abusive manipulative behaviour could still be casually ignored by the victim.

I understand that this could all be seen as good fun: testing our weird exes for signs of psychopathic behaviour (just one of a number of examples I could use). But to me, it also shows a fundamental confusion at the heart of our understanding of psychopathy.

On the one hand, to be diagnosed as a psychopath using the PCL-R is extremely difficult if you are not either committing a serious crime or living an extremely criminal-type lifestyle. Not only is the administration of the PCL-R lengthy and requires extensive experience and training, but you need to be, as leading psychopathy researcher Craig Neumann directly put it, a ‘nasty son of a bitch’ even to start to get up the scale. This means that the average middle-class reader of ‘Psychology Today’ is very very unlikely to have had much contact with a ‘clinical psychopath’.

And yet, on the other hand, there are piles of research being published about psychopaths in the community that tends to get a lot of press attention. These high profile studies purporting to identify psychopaths in the community get around the issue by asking people to fill in questionnaires about how psychopathic they are.

Of course, however, there’s a big problem here: a core trait of psychopathy is ‘pathological lying’: the inability to tell the truth in pretty much any situation.

So asking a psychopath if they are a psychopath is hit and miss at best and means that these scales are probably measuring something different. I would guess that ‘something’ is probably a kind of pathological narcissism, which shares a lot of features with psychopathy but has very different connotations for someone’s likely behaviour.

Gif from TV Fanatic — scene from ‘Killing Eve.’

None of this stops academics from pouring out articles and counter articles arguing about whether criminal behaviour is really a core part of psychopathy or not: and I am of course no less guilty of this than anybody else.

Similarly, the media seize upon every new article about psychopaths among us to roll out the same tropes linking it — usually wrongly— with famous serial killers. Researchers know this gets attention and liberally sprinkle their research with judgement-laden and scientifically dubious terms such as ‘the Dark Triad’. This is all fun for a while but once you’ve seen the “methodologically suspect research > newspaper article > psychologist interview” cycle once you’re not on tenterhooks for the sequel saying the same things two years later.


So why would someone so jaded about everything that psychopaths represent want to write books and articles? Well, alright: this is a blog post and I want you to read this so that I can make a broader point.

There are actually a great deal of really really interesting things about psychopaths that step outside the iron cage of the Psychopathy Test, including the developing idea that psychopathy actually describes a range of very different personalities. I’ll give you two more for starters.

The first idea, which goes all the way back to the first real account of psychopathy, Herve Cleckley’s The Mask of Sanity, is that psychopaths actually have a deep core of true psychotic insanity within them, overlaid with a superficial ‘mask’. Some psychiatrists and psychologists still put credence in this theory and that there is a significant connection between core psychopathic traits and psychosis, which might even make psychopathy protective of insanity.

A second question is: how do you treat someone with a disorder such as psychopathy that means they struggle to learn from experience? In the face of an overwhelming therapeutic nihilism, overly inherited perhaps from some missteps such as naked encounter therapy or LSD treatment new ideas are thin on the ground. Some challenging groundwork on this was done by the UK Prison Service and the Westgate Unit with the Chromis Programme — that seeks to elicit treatment motivation on psychopathic offenders’ own life goals rather than desistance alone — and I am excited by new attempts to trial group-based mentalising therapies with sociopathic men.

Mentalising effectively ‘teaches’ people skills of emotion recognition and description that they may never have learned whilst growing up: reconstructing the emotional development of personality.

LSD, madness, mentalising… surely I can’t be alone in thinking these are more interesting things than another poorly-written media article on the Psychopathy checklist?


NOTE FROM THE WRITER: Dr Mark Freestone is a Senior Lecturer in Psychiatry at Queen Mary University of London, a consultant on Series 1 and 2 of Killing Eve and author of ‘Making a Psychopath’, due to be published in May 2020 by Ebury Press.

NOTE FROM THE EDITORS: We are so pleased that we are able to bring you a blog from Dr Mark Freestone this week. Mark has had a very impressive and unique career and we are so glad that he was willing to share with us his personal experience working with criminal psychopaths. Thank you very much, Mark!


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