A Commentary on Ronson's The Psychopath Test: A Journey Through the Madness Industry The “psychopath test” in Ronson’s 2011 book is the Hare Psychopathy Checklist-Revised (PCL-R), first published by Multi-Health Systems in 1991, with a 2nd Edition in 2003. The PCL-R is the international standard for assessing psychopathy, the first personality disorder to be identified in psychiatry. As measured, it is a dimensional construct defined by a specific constellation of traits and behaviours including grandiosity, egocentricity, deceptiveness, shallow emotions, lack of empathy or remorse, irresponsibility, impulsivity, sensation-seeking, and a socially deviant (not necessarily criminal) lifestyle in which the feelings and rights of others are ignored or violated. We refer to individuals with a very high concentration of these features (perhaps 1% of the general population) as psychopaths. They are capable of inflicting a disproportionate amount of emotional, physical, and financial damage on those around them. Unfortunately, the public tends to view psychopaths primarily as perpetrators of violent crimes, such as murder, sexual assault, and robbery. Many, of course, do commit serious crimes for which they are caught and sentenced. Yet, the majority of psychopaths are not in prison but living among us, where virtually everyone is victimized in one way or another, typically without understanding the “how or why of it.” For these reasons, I had hoped that Ronson’s book would serve to increase public awareness and interest in the nature of psychopathy and its devastating effects on large segments of society (see the web site for victims of psychopathy: http://aftermath-surviving-psychopathy.org/). I do not believe these hopes were realized. Indeed, a more appropriate subtitle for the book would have been Down the Rabbit Hole. Ronson’s intention apparently was to provide a journalistic treatment of the PCL-R and its role in the mental health and criminal justice “industries,” and its implications for the corporate world, with himself as the major player in a journey of discovery. Nothing wrong with this, but he might have provided some essential background information on psychopathy as a context for his task. More importantly, his depictions of the PCL-R and its use were superficial and inaccurate. The PCL-R is a controlled instrument restricted to trained researchers and to clinicians with the academic, professional and legal qualifications to conduct psychological evaluations. PCL-R assessments require careful integration of interview and collateral information according to strict scoring guidelines. It is not, as one uninformed reviewer opined, “…a simple 20-item checklist” (J. Schuessler, NY Times Sunday Review, May 27, 2011). Having attended a PCL-R workshop (described below), Ronson “emerged” as a “trained psychopath-spotter,” with a license to use his new skills in a mission to ferret out psychopaths in high places. In fact, his workshop experiences merely provided a useful backdrop for the cavalier use of the PCL-R in a journey into the madness industry. The title of the book notwithstanding, it may come as a surprise that Ronson actually did not describe the instrument, other than list its items, along with a few excerpts from the item descriptions. Most readers therefore will have little or no understanding of the PCL-R or of the reasons for its widespread use by researchers and clinicians in the mental health and criminal justice systems. Still, many will find his accounts of the journey to be entertaining, even beguiling and credible. Those familiar with the extensive clinical and research literature psychopathy and the PCL-R, the high standards set for the instrument’s proper use, and the potentially serious consequences of its misuse, may share with me a rather more realistic view of accounts: frivolous, shallow, and professionally disconcerting. By way of background, Ronson contacted me several years ago to ask if I would be interested in having him write about me and my work for his next book. Later, he wrote that what he was looking for most “ is a journey - something exciting that will take it out of the world of the academic” (February 27, 2009). Over the next few months we had several conversations, and I told him that he could learn a lot more by attending a PCL-R Workshop to be held in West Wales in August, 2009. Ronson received permission from the organizers to attend the workshop to facilitate research for his book, with a clear indication that the workshop would not qualify him to use the PCL-R. As a participant in the workshop, he was privy to a considerable amount of empirical information, mostly available in the literature on psychopathy, and a copyrighted Item Handout–that we require participants to return at the end of the workshop –containing formal detailed descriptions and scoring criteria for each of the 20 PCL-R items. Ronson included in his book item-titles (OK) and brief excerpts (not OK) from the Item Handout. He also watched several videotape case histories at the workshop, and had copies of their transcriptions, large portions of which found their way into the book (pp. 101-108 in the North American edition). This use of material from the Item Handout and the transcriptions occurred without permission. After the workshop Ronson wrote, “I still don't quite know what the narrative of the book might be, but if you were willing to be a kind of on-the-page mentor, even fellow traveller, I think it would be wonderful….I would keep you totally abreast of the way the book's going… (J. Ronson, personal communication, September 9, 2009). This did not happen. I learned about the book only when Condé Nast (GQ) magazine asked me to help fact-check an excerpt from a draft version, which in fact was not very factual. Ronson tells his readers that he started the PCL-R workshop a sceptic but came away “a Bob Hare devotee” [armed with] “a new power, like a secret weapon, the kind of power that heroes of TV dramas about brilliant criminal profilers display–the power to identify a psychopath merely by spotting certain turns of phrase, certain sentence constructions, certain ways of being.” This new power, if real, truly would be amazing, for not even the most astute clinicians and researchers possess it. Further, his power appears to reflect a misunderstanding of how clinicians actually score the PCL-R. Nonetheless, Ronson started to use his “new psychopath-spotting abilities” in a quixotic hunt for psychopaths in “the corridors of power.” To assist him in this quest he repeatedly called up specific PCL-R items and casually speculated on how they applied to a given individual. But even experienced clinicians score items by referring directly to their descriptions in the PCL-R Manual, a controlled instrument. How could Ronson have scored the items, other than from memory or by referring to the Item Handout? Further, while clinicians must integrate compelling evidence from a variety of sources (including, for example, interviews with the individual, file material, or interviews with people who know the individual very well) in order to score a given item, Ronson’ psychopath-spotting prowess allowed him to take unacceptable shortcuts. For example, consider his descriptions of some exchanges with a notorious financial legend (pp. 148-157). “If you want to get a friend, get a dog,” said Al. “We always had two. I hedge my bets.” Ronson said, “I wrote in my notepad, Glibness/Superficial charm.” Later he said, “I’ve got a list of personality traits written down here that define psychopathy” (p. 154). After he and Al discuss “Bob Hare” in rather unflattering terms, Al agrees to go through the list, which Ronson then pulls out of his pocket. Either the pocket was large enough to hold an unauthorized copy of the PCL-R Manual or the Item Handout, or the list consisted only of item titles. “Okay. Item one. Superficial charm,” asks Ronson. Al replies, “I’m totally charming.” Ronson then asks, “Grandiose sense of self-worth? This would have been a hard one for him to deny, standing as he was below a giant oil painting of himself.” Further evidence of this grandiose sense of self-worth was provided by Al’s statement that, “If you don’t believe in yourself nobody else will.” Ronson asks, “Manipulative?” Al replies, “I think you could describe that as leadership.” Presumably Ronson scored each of these items as present, although the actual scores he assigned are unclear. Throughout this and other encounters he whimsically wonders what “Bob” would do. Speaking for “Bob” I would have to say, not what Ronson did. In these and many other examples Ronson apparently based his conclusion that an individual warranted a high score on a PCL-R item on a few words, subtle phrasing, isolated behaviors, body language, assorted impressions, and his own insights into the nature of psychopathy. Ronson may think that this is what clinicians do, and perhaps his account of his experiences actually was a satire on the mental health industry, with the PCL-R as a visible and convenient framework. Even if this was the case, his portrayals of the instrument and of those who use it in research and clinical practice were fanciful and wildly off the mark. Ironically, in an interview (Star-Ledger Entertainment Desk, May 15, 2011) Ronson reportedly said that it was possible to “root out psychopaths…if you do it in a scientifically correct way” (emphasis mine). Even if done in a “scientifically correct way” it is important to understand that clinical impressions and inferences play an important role in scoring many of the PCL-R items. The resulting total scores, while acceptably reliable, are subject to measurement and other errors, with the result that similarly qualified clinicians may assign somewhat different scores to a given person, though usually within a reasonably narrow range. This is well-recognized by researchers and clinicians, who take rating errors into account when interpreting PCL-R scores. Individual item scores are even less reliable than total scores, and no reputable clinician would ever do as Ronson did: Use a few behavioural tidbits to “score” an item or two and extrapolate from these scores to a “diagnosis” of psychopathy. Ronson’s reported use of his amateur skills to score a few PCL-R items and thus to “spot psychopaths” is playful but inapt. Of course, it does not take an expert to recognize that the behaviors of a given individual create serious psychological or physical problems for those around him or her. As social creatures we often make judgments of others, and our well-being may depend on being reasonably successful at doing so. In making such judgments people often are misled by first impressions of the individual, incomplete or fallacious information, an appealing or credible façade, and the natural hope that those with whom they deal share their ethical and moral standards. But, when they are wrong and the façade begins to crack, they are faced with trying to make sense out of the distress, turmoil and pain that they and others now experience. These victims typically have a great deal of information about the other person– partner, relative, friend, co-worker– and no doubt many correctly identify the person as having a heavy concentration of traits and behaviors consistent with pychopathy. Several popular books (including Without Conscience and Snakes in Suits) describe the salient features of psychopathy and offer readers options on what to do if they suspect that they are involved with individuals with these features. Most of these options involve the judicious use of common sense and caution, not always easy or feasible to carry out. But the goal is to resolve the situation as painlessly as possible, and formal psychiatric assessments may not be necessary. But, if one is required it should be done by qualified professionals who will evaluate and integrate relevant information from a variety of sources. This is quite different from Ronson’s approach, which relies on the perceived presence of a few isolated features and the perfunctory use of a clinical scale to suggest that a person might be “psychopath.” There certainly is nothing wrong with mixing fact and fantasy to spin a good tale, and to play entertaining pseudo-diagnostic games along the way. The internet contains hundreds of such games and quizzes for almost every psychological condition imaginable, some of which Ronson expressed concern that he might have. Most of us realize that these recreational pastimes have little real world validity and we really don’t take them seriously. Formal clinical evaluations of psychopathy, on the other hand, have substantial implications for the individual and for society. Although judges, prosecutors, defence attorneys, administrators, and investigators attend PCL-R workshops (as well as seminars and workshops on various risk assessment tools) in order to learn something about the people with whom they encounter in the course of their work, they are not deluded into believing that they now are trained psychopath assessors. If anything, they come away with an appreciation that the assessment of psychopathy requires clinical training and skills, and that the results and their interpretation must be consistent with the ethical, professional, and legal issues associated with the use of psychological instruments that impact individuals. Ronson’s antennae may be tuned to psychopathic signals– whatever they may be–but he should not pretend that they quiver because of his exposure to the PCL-R. His casual simulation of a PCL-R assessment is irresponsible, even in the guise of a humorous literary journey of discovery into the madness industry. He is a journalist and I’m a scientist, and I certainly would not do what he has done. He might argue that he and I ultimately share similar goals: To investigate, inform, and perhaps entertain. However, even when entertaining, scientists generally do not mix fact and fiction unless the reader knows that they are doing so (e.g., in science fiction or speculative science-based documentaries). I was bemused (as I’m sure were other scientists) by the lack of conceptual and factual fidelity in his caricatures of what we know about brain function and structure in psychopathy. I can assure readers that Ronson’s understanding and reporting of my views (and those of other researchers cited, including Essi Viding) are confused and simplistic. I particularly was disturbed by some of Ronson’s contrived descriptions of his interactions and conversations with me. For example, not only does he conflate my early studies of threatened pain (mild shock to the fingers) with much later ones on brain function, his descriptions of these early studies and my reactions to them are convoluted, and false. Referring to these studies (pp. 95-96) Ronson said, “It was inevitable that civil rights groups would eventually force a reining in of the experiments. And sure enough, disastrously for Bob Hare, electric shocks were outlawed in the early 1970s….He seemed annoyed by the legislation, even now, years later.” This depiction of events (civil rights groups, outlawed, legislation) and my reported reactions to them (annoyed) are complete fabrications. The same can be said of many of his other reports of our conversations. I can’t help but wonder if some of Ronson’s accounts of his experiences with others in his book are equally fictionalized. I leave it up to others to review and comment on the literary merits of the book. I realize that as a journalist Ronson’s aim was to weave a plausible yarn about psychopathy and its role in society, particularly in the corporate world. Still, as an active researcher in this area, I was disappointed that the rich clinical traditions and the recent empirical findings regarding psychopathy and its measurement received little attention, except in a superficial sense and perhaps as part of a literary parlour game. Perhaps the book, with its many blind alleys, dead ends, red herrings, and quasi-investigative journalism, largely was written with tongue-in-cheek. Showbiz, that is! Still, I’m concerned that readers not familiar with the literature on psychopathy will take seriously what Ronson has written, and will draw some wrong conclusions from his book and his many media appearances. Some will develop a tenuous belief that they now have deep insights into the enigma (“madness” according to Ronson) that is psychopathy. Some will have the erroneous idea that, with a “simple list,” they too could be armed against psychopaths. As a recent email to me stated, “I would like to know about psychopath-spotting courses in my area” (July 15, 2011). In an interview (A. Williams, Metro, June 14, 2011) Ronson reportedly said, “I was really concerned Robert Hare would be unhappy with what I’d written but he emailed to say he loved it.” Not quite. What I actually said in an email (May 5, 2011) was, “First impressions: Very interesting.” My final impressions are less positive, at least with respect to its depiction of psychopathy and its measurement. As a frequent guest on TV Ronson, appears to present himself as an adept psychopath spotter. If he was an upfront humorist it would be clear to the audience that he merely is playing a role and that he is not to be taken seriously. But, this is not the role he plays, with the unfortunate consequence that many in the audience may view him as an informed purveyor of factual and helpful information on psychopathy, rather than as the author of a parody of what really goes on in the mental health and criminal justice systems. Perhaps readers of Ronson’s book will be motivated to investigate for themselves the real efforts of the many clinicians and researchers, and the experiences of the countless victims around the world, who are striving to understand and cope with the difficult problem that psychopathy poses for them and for society. An important link to the major international society for scientific research on psychopathy is www.psychopathysociety.org. My website (www.hare.org) contains a detailed list of publications on the topic. As a final, more personal thought, I am perplexed by Ronson’s description of me as “a quite feral-looking man with yellow-white hair and red eyes, as if he’d spent his life in battle, battling psychopaths, the very forces of evil.” The feral part is debatable, but I note for the record that my hair is silver-grey (titanium?) and my eyes baby blue. Robert D. Hare, Ph. D. Emeritus Professor of Psychology University of British Columbia Vancouver, BC April 16, 2012 www.hare.org Download this comment as a PDF Also see: On Ronson: A general commentary by Hare and colleagues on Ronson's book The Psychopath Test. Book Review of Ronson's The Psychopathy Test: This is a detailed and informative review of Ronson's book.