Help! My Patient is a Psychopath!
Unfortunately, your psychopathic patient is not as easy to identify as the fellow in the pix. He or she will be quite charming and attentive. If you aren’t careful, you will be drawn right into his current scam. Nurses working medical are not always savvy about the ways of the criminally insane. Always be on the alert for the subtle manipulation of the psychopath. There are many of them to be found in corrections. Although an estimated 1% of the general population have this condition, between 15-20% of your inmate-patients could be classified as psychopathic. Become familiar with the characteristics so you can be on guard.
What to Look For
Robert Hare, PhD, considered the top expert on the Psychopathic Personality, created a list of common characteristics. How many of them describe patients arriving at your sick call or medication line?
Characteristics of a Psychopath
- superficial charm
- self-centered & self-important
- need for stimulation & prone to boredom
- deceptive behavior & lying
- conning & manipulative
- little remorse or guilt
- shallow emotional response
- callous with a lack of empathy
- living off others or predatory attitude
- poor self-control
- promiscuous sexual behavior
- early behavioral problems
- lack of realistic long term goals
- impulsive lifestyle
- irresponsible behavior
- blaming others for their actions
- short term relationships
Protect Yourself
Unless you are working the mental health side, your job is not to ‘treat’ the psychopathy, but to be aware of it and protect yourself. Psychopaths will use every interaction to their advantage. They are astute at discerning another person’s vulnerabilities and they prey on hurting people. Staff members who are lonely, insecure or self-involved are good candidates for the manipulation of a psychopathic inmate. Nursing careers have ended when nurses have been drawn into sexual relationships or nefarious activities such as smuggling contraband or diverting narcotics for these individuals. Guard yourself. Know the characteristics. Keep yourself and your teammates accountable to stop potential issues before they move to a dangerous level.
Firm, Fair, Consistent
Protect yourself by treating all inmate-patients with strict professional behavior and demeanor. Follow all security rules of conduct. Here are a few tips.
- Don’t get personal. If an inmate comments about your hair or your figure, call them on it. If the comments continue, report them.
- Do not perform even the smallest ‘extra’ activity for an inmate. That cotton ball or paperclip is the first step down a slippery slope.
- Treat all inmates with equal respect and professional distance. Do not show any favoritism and do not allow any in return.
- If you think you may have already been compromised, report it immediately to your supervisor and take actions to halt the progression. This may include reassignment to another care unit to break the connection.
Have you come across psychopaths as described above in your practice? Tell us your experiences in the comments section of this post.
Resources:
How Psychopaths Choose Their Victims
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Excellent article. I have been a RN for over 25 years and have worked in corrections for the past 10 (although not in nursing but on the treatment side).
My most memorable experience was with a lifer who could recount his heinous crime without a hint of emotion. And yet a person who did not know him would perceive him as a kind, amiable, ever-smiling, charming fellow.
Although there are those who are truly evil, and those who have serious mental illness, there are also those who are capable of change and who leave to live productive lives in the community.
Your rules under the “firm, fair and consistent” heading are right on. I have seen too many people compromise them to their loss.
Thanks for your input, Sam…Excellent example of some of the characteristics listed in the post. It is so easy to be drawn in.
Excellent review of a very important topic! Anyone, but especially those in corrections should be sure to read, “Games Criminals Play” by Allen and Bosta. In my opinion it’ll reduce the chances that you’ll get taken.
Great suggestion! I think we used a video in orientation called “Games Cons Play” or something like that. Gave some good examples of how staff can be drawn in.
The Mask Of Sanity by Hervey Cleckley is an excellent resource/book for in depth analysis of the psychopath. It is the bible for sociopathy. Robert Hare puts it into an easier to follow format, but Cleckley pioneered the research a long long time ago. The book is available free online at:
http://www.cassiopaea.org/cass/sanity_1.PdF
Awesome resource! Thanks for sharing it and posting to the site. I’ll add it here and on my Resources page.
I’ve been in law enforcement for over ten years (police officer and later detective) and only until recently in the last few years have we begun training at my department on the Characteristics of a Psychopath. I think some people have more noticeable characteristics than others and many are never diagnosed.
Thanks for the comment, Dakota: I agree that this is a condition we need more education about. There are plenty of psychopaths walking the streets and so many of them pass through our facilities. We need to know how to protect ourselves as a part of our jobs.
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