The Mark Of Cain: Psychoanalytic Insight And The Psychopath (Book Review)

Title:  The Mark Of Cain: Psychoanalytic Insight And The Psychopath
Author:  Meloy, J. Reid (Editor)
Publisher:  Analytic Press, 2001
Reviewed By:  Marilyn S. Jacobs, Spring 2003, pp. 51-52

The Mark of Cain: Psychoanalytic Insight and the Psychopath, by J. Reid Meloy, is the first published collection of psychoanalytic papers on the phenomenon of psychopathy. The underlying premise of the book is that psychopathic minds are formed by early developmental failures and that one can apply a psychoanalytic formulation of character structure to understand the psychopathology of these disorders. The articles in this anthology are presented chronologically and are organized into two sections, “Development and Psychodynamics” and ‘Treatment, Risk Management and Psychodiagnosis.” The author provides a very concise and useful introduction to each of the two sections as well as a brief commentary prior to each article. This excellent organizational strategy provides the reader with an exceedingly useful and clear reference on the subject of psychopathic personality.

This book is of unique value, as the professional literature concerning the criminal mind tends to be either sociological or biological. If psychology is referenced, the perspective is usually behavioral or cognitive-behavioral. This book provides ample evidence that psychoanalytic thinkers have contemplated this clinical problem for some time.

Dr. Meloy has worked in a variety of capacities of forensic mental health settings for many years. He relates in the preface that early in his career he became interested in what the psychoanalytic literature would suggest was clinically useful concerning the phenomenon of psychopathy. Some of this curiosity evolved from his background in history. He was seeking what was thought about the internal life of persons who were deemed untreatable by the institutions within which they were incarcerated or referred for management.

Dr. Meloy’s work is a book that culls from the psychoanalytic literature yet includes references to other fields, including psychological, biological and social research. In discussing his work and the considerations in preparing this volume, Dr. Meloy is very honest about the difficult aspects of working with this population and thus contemplating their personality traits and characteristics. Dr. Meloy’s idea for this book was to provide a useful resource. He reports that he had significant difficulty in his search for a publisher. The major issue was that the reprint permission fees were considerable. This daunting problem was solved with a generous grant from the John Jay College of Criminal Justice Foundation. That entity is owed a debt of gratitude for their support of this most valuable work. Aside from its theoretical and technical value, this collection of works is a fascinating treasure trove of historical material, which traces the development of psychoanalytic thinking in and of itself over the years of the 20th century. I was particularly struck by the use of language to describe various clinical processes. Since some of the terminology is not currently used to classify clinical phenomenon, it provided additional richness to the text.

The summaries for each of the two sections provide exceedingly useful compendia of what is known about the psychopathic personality. In the first section, developmental issues are considered. The writings presented reveal the complexity of this topic. A seminal point that Dr. Meloy presents early on is that, “The house of psychopath is built on a psychobiological foundation of no attachment, underarousal and minimal anxiety” (p. 3). Hence, there is a particular predisposition to psychopathic development. This characterological picture leads to a basic failure of internalization with a severe narcissistic psychopathology, primitive internalized object relations and superego abnormalities. Furthermore, there is what Dr. Meloy calls “part-object emotions” (p. 16) and a preponderance of pre-Oedipal defenses. The psychopath “possesses an emotional range and depth and object relatedness similar to–although not identical with–those of a young toddler prior to sustained interaction with his peers”(p. 16).

The articles that follow cover a wide spectrum. David M. Levy (1937) discusses affect hunger and maternal rejection as a cause of the chronic emotional detachment of psychopathy. John Bowlby (1944) presents some his early notes on the psychopathology of a sample of “juvenile thieves” with an emphasis upon how a lack of attachment causes negative internal representations and a presence of aggression. Phyllis Greenacre (1945), comments how “constitutional psychopaths” fail to develop a conscience due to faulty structural development, characterized by impulsivity and emotional lability. Other authors from early in the psychoanalytic movement include Laretta Bender (1947) who presents her observations of institutionalized children and Kate Friedlander (1949), who uses Aichorn’s concept of “latent delinquency” to illustrate a case where environmental disturbance in ego development create superego dysfunction.

Helene Deutsch (1955) describes the importance to “single out from the many varieties of psychopathic personality one particular type and to attempt to understand him” (p. 115). She thus details the psychoanalytic treatment of a 14-year-old boy who she calls “The Imposter.” The classic paper of D.W. Winnicott, “The Antisocial Tendency,” is included. In this work, the author depicts the problem with hopefulness with the view that “where there is an antisocial tendency there has been a true deprivation … that is to say, there has been a loss of something good that has been positive in the child’s experience up to a certain date, and that has been withdrawn … “ (p137). Other papers include discussions of time and character disorder, psychopathy, freedom and criminal behavior and the psychology of wickedness.

The section on diagnosis, risk management and treatment deepens the readers understanding of psychopathy. The overview discussion summarized issues relating to transference, countertransference, and the question of treatment or risk management, psychodiagnosis, character pathology, diagnostic classification systems and psychological testing. It is noted that there are very few papers, which depict analytic treatment of psychopathy. This is qualified by the reminder that there is very little if any evidence that individuals with psychopathic personality will benefit from psychodynamic therapy of any type. What has been published thus is more focused upon a discussion of the “psychoanalytic way of knowing the psychopath” (p. 183) through countertranference reactions.

This section includes several classical psychoanalytic papers, by such writers as Wilhelm Reich (1926), (“the phallic narcissistic character”), August Aichhorn (1935), (“the narcissistic transference of the juvenile imposter”), Betty Joseph (1960), (“characteristics of the psychopathic personality”), Neville Symington (1980), (“the response aroused by the psychopath”), and Otto Kernberg (1989), (“the narcissistic personality disorder and the differential diagnosis of antisocial behavior”).

It occurred to me that so many of the psychoanalytic concepts referred to in these articles were quite familiar to me. However, I had not seen many of these applied to the understanding of psychopathy before reading Dr. Meloy’s compendium. Thus, the book will undoubtedly enlarge the average psychoanalyst’s mind to further applications of what is already known and as a reference on the subject.

My only question I reading The Mark of Cain was the lack of representation from the contemporary psychoanalytic literature. I wondered whether or not there were papers extant that included work on the neurobiology of attachment and traumatic stress as it was applied to psychopathy. Perhaps this fact derives from the reality that there are no such writings. If this is the case, one hopes that Dr. Meloy will continue to publish psychoanalytic writings on this most difficult clinical problem as knowledge evolves. I can see that this work could be the first in a series that considers this subject.

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