This multi-author book consists of ten chapters covering various aspects of psychopathy, without much attempt at continuity. The first chapter provides a description of a clinical service within a UK prison, the final chapter offers a broad literature review of treatment options, and a very brief chapter on assessment sits uneasily somewhere in the middle. A research paper setting out an MRI study of psychopathic and non-psychopathic offenders sits next to a thought-provoking, albeit speculative chapter on societal influences on the adaptive psychopath. Still, there is interesting content here – including how to maintain a healthy staff group in a clinical service, psychometric investigations of personality structure in psychopathy and the stability of psychopathic traits over time.
Among these disparate essays are two chapters on ‘criminal autistic psychopathy’ written by the editor; I think these are the book's true purpose. Professor Fitzgerald points out that Hans Asperger described his syndrome as ‘autistic psychopathy’. The meaning of psychopathy has changed since then – from a general term for pathology of personality to a specific type of personality pathology. Fitzgerald would have us read the modern restrictive meaning into Asperger's description.
While he regards autism as a spectrum disorder, he insists that criminal autistic psychopathy is categorical. He does not worry about using a complex, social and behavioural construct such as criminality to define it. He tilts at the windmill of those who deny the truism that sometimes people with autism commit offences, as though their co-occurrence was evidence for a new diagnosis. Selectively noting snippets of biography, he says of various serial killers, for example: ‘I believe criminal autistic psychopathy would be the modern diagnosis’ – if it were a modern diagnosis, presumably.
The relationship between autism and psychopathy is complex and probably heterogeneous. A synthesis of the current research on callous unemotional traits and autism, on lack of empathy or inability to mentalise as common psychobiological characteristics, or on shared neural networks would interest many clinicians, especially if it offered the prospect of better therapeutic interventions for offenders with either or both disorders. But the existence of criminal autistic psychopathy as a diagnosis increasingly feels like a matter of faith, as Fitzgerald urges us just to take his word for it. It is difficult to accept such a reductionist and pejorative model of behaviour and abandon individual formulations of offending, which can encompass the impact of autism on perception, emotion, learning and cognition for the whole complex individual in particular, complex situations.
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