In 1806, French doctor Philippe Pinel created a category of mental disorder, manie sans délire, or insanity without delirium, which was a forerunner to modern psychopathy.1 His case studies of some who presented intractable and immutable disorders were harbingers of the long-held belief that the disorder may be irreversible and untreatable.

Nearly 150 years later, American psychiatrist and psychopathy pioneer Hervey Cleckley cataloged cases of psychopaths he had analyzed in his seminal work, The Mask of Sanity, and developed a list of character traits that were common to all.2 Based on these cases and informed by his other psychiatric practice, he reached a conclusion that still resonates and causes consternation among some researchers: Cleckley determined that treatment was unavailing.3

In the 1988 and final version of The Mask of Sanity, Cleckley wrote:

"I have now, after more than three decades, had the opportunity to observe a considerable number of patients who, through commitment or the threat of losing their probation status or by other means, were kept under treatment not only for many months but for years. The therapeutic failure in all such patients observed leads me to feel that we do not at present have any kind of psychotherapy that can be relied upon to change the psychopath fundamentally. Nor do I believe that any other method of psychiatric treatment has shown promise of solving the problem."4

This assertion was largely reinforced by the work of the preeminent psychopathy researcher Dr. Robert D. Hare in the 1970s and 1980s. He summarized his observations based on his experiences with clinical psychopaths who scored 30 or above on his gold-standard instrument, the Psychopathy Checklist-Revised ("PCL-R").

In his popular work,........

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