Are psychopaths psychotic?


It is said that psychopaths aren’t insane, because they have an absence of delusions and other signs of irrational thinking. Is this correct? Something about it doesn’t seem quite right.

In properly diagnosed psychiatric disorders, psychosis is a descriptive term for the hallucinations, delusions, impaired insight, and sometimes violence, that may occur. Psychosis is generally given to noticeable deficits in normal behavior and more commonly to hallucinations or delusional beliefs, including in the relation between self and others, as in grandiosity and paranoia.

Hmmm… Delusions? Check. Violence? Check. Impaired insight? Check. Grandiosity? Check. Deficits in normal behavior? (they might not always be ‘noticeable,’ but they’re definitely there). Check.

Couldn’t their pathological sense of grandiosity be considered a delusion of grandeur?

“A delusion of grandeur is the fixed, false belief that one possesses superior qualities such as genius, fame, omnipotence, or wealth. It is most often a symptom of schizophrenia, but can also be a symptom found in psychotic or bipolar disorders, as well as dementia (such as Alzheimer’s).” John M. Grohol, Psy.D.

A delusion is a fixed, false belief. It’s “an idiosyncratic belief or impression that is firmly maintained despite being contradicted by what is generally accepted as reality or rational argument, typically a symptom of mental disorder.”

Consider that psychopaths believe humans are nothing more than objects. Complex objects, but objects all the same. Because of that belief, they feel free to manipulate, use, and discard. Isn’t that delusional?

Ted Bundy, the psychopathic serial killer, said “Sometimes I feel like a vampire.” The psychopath I was involved with told me many times that he was a vampire. That seems delusional to me.

Speaking of Ted Bundy —  who viciously murdered up to 100 people — I have to wonder how he could NOT be insane. Does a sane person kill others for sport, enabled by their absolute disregard of their victim’s value or humanity? Not that I know of.

Because Bundy was an ‘organized’ serial killer — his crimes were not spur-of-the-moment-decisions, but carefully planned and executed — he didn’t fit the standard, accepted definition of psychotic. But can the thoughts that drove his behavior really be considered ‘rational thinking’?

He was intelligent and articulate, had a degree in psychology, and was handsome and clean cut. His outward appearance gave no clue to his ‘deficits in normal behavior,’ but that doesn’t mean those deficits weren’t there. Maybe those deficits in normal behavior weren’t always noticeable,  but they certainly were as he killed all those people. Glaringly noticeable.


Ted Bundy (notice his body language — his grandiose, ‘haughty’ demeanor and air of superiority, even though he was involved in a capital murder trial)


“Psychopaths don’t exhibit the manias, hysterias, and neuroses that are present in other types of mental illness. Their main defect, what psychologists call ‘severe emotional detachment’—a total lack of empathy and remorse—is concealed, and harder to describe than the symptoms of schizophrenia or bipolar disorder. This absence of easily readable signs has led to debate among mental-health practitioners about what qualifies as psychopathy and how to diagnose it. Psychopathy isn’t identified as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association’s canon; instead, a more general term, ‘antisocial personality disorder,’ known as A.P.D., covers the condition. ” From the article “Suffering Souls,”  about the work of psychopathy researcher Dr. Kent Kiehl.

Kiehl is “frustrated by the lack of respect shown to psychopathy by the mental-health establishment.” Because of it, he says, hardly anyone is funding research into the science.

Dr. Robert Hare also disagrees with psychopathy being classified as antisocial personality disorder. He says, “It’s like having pneumonia versus having a cold. They share some common symptoms, but one is much more virulent.” Hare sees his work as warning society of a devastating and costly mental disorder that it mostly continues to ignore.

In the first edition of “The Mask of Sanity,” Hervey M. Cleckley described his psychopathic patients as “frankly and unquestionably psychotic,” but modified this in later editions. He agreed with other professionals who felt it would stretch the definition of psychosis too far. However at various other points he still suggested that, despite ‘traditional’ classification, the extent of the inner abnormality and associated dysfunction in psychopathy is such that it might be considered as psychosis in many respects.

One psychopath described his mental state to me not as insanity, but as “forming models of reasoning that are different from the norm.” He attributed this to a lack of emotional attachment to common ideas and accepted values. Might that mean a lack of attachment to reality?

What confuses the issue is the assertion that psychopaths do know right from wrong, but they just don’t care. That’s true, but it muddies things up by implying that they can act differently if they only choose to. But then we turn around and agree they have this serious mental disorder called psychopathy that’s responsible for their lack of a conscience and for their inability to feel remorse or to love or care about others. Which is it — are they simply normal people who make bad choices and who could change if they wanted to, or do they have a mental/neurological disorder that makes doing the right thing very difficult or even impossible? How can it be both?

“It turns out that an eerie type of chaos can lurk just behind a facade of order – and yet, deep inside the chaos lurks an even eerier type of order.”

~ Douglas Hostadter

Maybe psychopathy is simply a psychosis the victim is able to conceal. That doesn’t seem to make sense within the standard definition of psychosis, but it describes the psychopath. In the 1940’s, there was a psychiatrist who classified psychopaths as “non-sane, non-insane.” That doesn’t make sense, either… yet in a way it does.

Here’s what one anonymous psychopath has to say about it:

“It’s funny because ‘inside’ is much more chaotic than I show. It is an interesting paradox because inside my head I am positively insane but ‘outside’ my head I am perfectly normal (when need be)… There are two people in my head and they both think differently. One controls my thoughts and the other, my actions…. The one who controls my thoughts tries to sway me one way or the other, but ultimately I decide who’s argument has the most merit. In reality, insanity is only characterized by your actions. Having voices in your head doesn’t make you crazy; following their will in a public setting does.”

~ ZKM, Sociopath’s Domain  (Warning: Readers may find this material disturbing)

One thing is certain—psychopathy is a perplexing disorder.



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