Quelques éléments en faveur d’une réflexion psychopathologique sur la psychopathie : seconde partie

Abstract: Objectives: The objectives of this study are to offer some clinical and semiological considerations for a psychopathological conception of psychopathy. In the first part, the author provides a history of this diagnosis (see Introduction of this paper) and a description of the current trends in the international literature: the contributions of R.D. Hare and the PCL-R, D.J. Cooke and the Comprehensive Assessment of Psychopathic Personality (CAPP) and T.H. Pham for French-speaking validations (subtitle 2 of this paper). After that, the author proposes a definition of psychopathology in the sense of Minkowski and Jaspers proposals (i.e. these latter come from the principles of the continental phenomenology) (subtitle 3 of this paper). Patients and methods: This theoretical essay is improved by clinical situations. The psychopaths were interviewed in prison or in forensic centers. The method used was a psychopathological analysis from the clinical material, as well as references to the phenomenological psychopathology (continental phenomenology) and the philosophy of J.-P. Sartre, M. Foucault and P. Ricœur. Results: This study shows that it is useful to consider a psychopathological reflection on psychopathy and this approach gives a framework for the clinical investigations. Regarding that, the author proposes a first comparison between the binswangerian conception of mania and the psychopathic functioning (subtitle 4 of this paper). By this way, we can understand why many studies show a positive correlation between the scoring in the PCL-R and the scale of the MMPI mania. The behavior is similar but the difference is about the dialectic between the “ego” and the “alter ego”. The maniac has a fundamental crisis of the “ego”, which the psychopath does not have. A second finding of our investigations concerns emotions and the dimension of the adaptive psychopathic disorder (subtitle 5 of this paper). An epistemological discussion of the concept of emotions allows us to say that the psychopath is competent in the management of emotional stimuli, which confers a psychological advantage to him. In addition, fundamental research on the management of the emotional stimuli in the psychopath seems to confirm our hypothesis of an adaptive dimension for the psychopathic disorder. The last point we discuss is about “morality” and “ethics” for the psychopath (these notions are from the concepts of empathy and sympathy). On the basis of Foucault''s distinction between these two concepts, it becomes possible to study these dimensions and integrate them in the practice of psychopathology. This proposal enables to introduce the concept of narrativity. This observation prompts the clinician to listen to the patient and to pay attention to how he has to tell himself. Conclusions: Our contribution shows that it is possible to conduct a study about the psychopathology of psychopathy. Our study is not intended to be complete and irrefutable. Our goal is rather to give some evidence for a psychopathological consideration on psychopathy (as indicated by the title of this paper). Finally, we offered some thoughts on the practice of psychotherapy by integrating the adaptive dimension of this disorder which, when it is missed, can lead to a psychotherapeutic stalemate. [Copyright &y& Elsevier]