Cross-cultural research by Murphy ( 1976 ) on psychopathy reveals that it occurs in a wide range of cultures including nonindustrialized ones as diverse as the Inuit of northwest Alaska and the Yoruba of Nigeria. The Yoruba people’s concept of a psychopath is “a person who always goes his own way regardless of others, who is uncooperative, full of malice, and bullheaded,” and the Inuit’s concept is of someone whose “mind knows what to do but he does not do it…. This is an abstract term for the breaking of the many rules when awareness of the rules is not in question” (Murphy, 1976 , p. 1026). Nevertheless, the exact manifestations of the disorder are influenced by cultural factors, and the prevalence of the disorder also seems to vary with sociocultural influences that encourage or discourage its development (Cooke et al., 2005 ; Hare et al., 1999 ; Sullivan & Kosson, 2006 ).
Regarding different cross-cultural manifestations of the disorder, one of the primary symptoms where cultural variations occur is the frequency of aggressive and violent behavior. Socialization forces have an enormous impact on the expression of aggressive impulses. Thus it is not surprising that in some cultures, such as China, psychopaths may be much less likely to engage in aggressive, especially violent, behavior than they are in most Western cultures (Cooke, 1996 ). By contrast, cross-cultural studies have indicated that the affective-interpersonal dimension of psychopathy is the most consistent across cultures (Cooke et al., 2005 ).
Moreover, cultures can be classified along a dimension distinguishing between individualistic and collectivist societies. Competitiveness, self-confidence, and independence from others are emphasized in relatively individualistic societies, whereas contributions and subservience to the social group, acceptance of authority, and stability of relationships are encouraged in relatively collectivist societies (Cooke, 1996 ; Cooke & Michie, 1999 ). Thus we would expect individualistic societies (such as in the United States) to be more likely to promote some of the behavioral characteristics that, carried to the extreme, result in psychopathy. These characteristics include “grandiosity, glibness and superficiality, promiscuity … as well as a lack of responsibility for others…. The competitiveness … not only produces higher rates of criminal behavior but also leads to an increased use of … deceptive, manipulative, and parasitic behavior” (Cooke & Michie, 1999 , p. 65). Although the evidence bearing on this is minimal, it is interesting to note that estimates of the prevalence of ASPD are much lower in Taiwan, a relatively collectivist society, than they are in the United States (approximately 0.1 to 0.2 percent versus 1.5 to 4 percent).
Treatments and Outcomes in Psychopathic and Antisocial Personality
Most people with psychopathic and antisocial personalities do not experience much personal distress and do not believe they need treatment. Those who run afoul of the law may participate in rehabilitation programs in penal institutions, but they are rarely changed by them. Even when more and better therapeutic facilities are available, effective treatment will still be a challenging task, and many clinical researchers working with these populations have concluded that these disorders are extraordinarily difficult (if not impossible) to treat, with psychopathy being even more difficult to treat than ASPD (e.g., Hare et al., 1999 ; Harris & Rice, 2006 ; Vitale & Newman, 2008 ). Such conclusions are not made lightly. Dozens of treatment studies have been conducted. Alarmingly, a few studies have found that treatments that work for other criminal offenders can actually be harmful for psychopaths in that rates of reoffending increase rather than decrease (Harris & Rice, 2006 ). This may be especially likely to occur if the treatment program emphasizes training in social skills or empathy because such skills may simply make them better at charming or conning future victims (Vitale & Newman, 2008 ).
Biological treatment approaches for antisocial and psychopathic personalities—including electroconvulsive therapy and drugs—have not been systematically studied, partly because the few results that have been reported suggest modest changes at best. Drugs such as lithium and anticonvulsants used to treat bipolar disorder have had some success in treating the aggressive/impulsive behavior of violent aggressive criminals, but evidence on this is scant (Markovitz, 2001 ; Minzenberg & Siever, 2006 ). There have also been some tentative but promising results using antidepressants from the SSRI category, which can sometimes reduce aggressive/impulsive behavior and increase interpersonal skills (Lösel, 1998 ; Minzenberg & Siever, 2006 ). However, none of these biological treatments has any substantial impact on the disorder as a whole. Moreover, even if effective pharmacological treatments were found, the problem of these individuals generally having little motivation to take their medications would remain (Markovitz, 2001 ).