One can imagine that these imprisoned men and women could act violently and impulsively when chained up (much as an animal can be more aggressive when constrained by a leash). What happens when there are no longer the chains? One must monitor their own behavior or be considered “mad” by all those around them. It no longer does any good to lash out or scream. As Richard Sennett (1980) noted with regard to indifferent authority, why would anyone scream if there is no one to really care or pay attention. If I am not a sideshow, then I am left to rot in a large, impersonal institution like the “Salpetriere. This is the ultimate source of alienation and minimalization of self.
In modern mental institutions (and prisons), the malady being exhibited most often by a patient (or inmate) after six to eight months of confinement is likely to be attributable not to the entering behavioral problem but instead to the environment in which this patient is now living (“institutionally-induced madness”). As human beings, we are quite adaptable in response to the unique pressures and opportunities offered by the setting in which we find ourselves. Thus, the powerful and quite controlling setting in which patients (and inmates) find themselves can produce its own unique behavior patterns. Those who are ‘Mad” (social deviants) in the outside world, become perfectly adjusted to the “madness” of the institution in which they now dwell. There is truly an internalization of the chains—whether at the 18th Century Salpetriere or 20th Century mental hospital portrayed (with considerable accuracy) by Ken Kesey (1963) in the novel, play and movie, One Flew Over the Cuckoo’s Nest.
Psychopathy and Social-Class
The assumptive world of social deviance is ultimately about social class. Social control is exerted most successfully in a setting where there is a disparity in economic status and political power. The mixing up of poverty and madness in European (and American) societies was no accident—this mixture, as I have noted, was sprinkled with either sin or predestination, just as the internalization of chains through inculcation of shame was directed primarily at those who had no control over the institutional chains (hospital or asylum) in which they were imprisoned.
Social class also impacts on psychopathy in a more universal and destructive way. Recent epidemiological studies point to an important correlation between sources of pathology (such as sustained stress) and social class. If you are poor, then you are more likely to exhibit signs of chronic stress (e.g. high blood pressure and elevated glucocorticoids), which, in turn, lead to such psychopathological states as incapacitating anxiety and depression. For those in the lower social economic classes there is also less accessibility to treatment of these states and fewer treatment options are available.
As we turn specifically to the treatment of psychopathy, we find that psychopharmacological and psychotherapeutic treatments either can’t be afforded or are not readily available where these people live. It is a simple and tragic formula: the lower the social-economic level, the greater the stress and vulnerability–and the less accessible are appropriate and effective treatment plans. I would suggest that the third assumptive world of psychopathy with its focus on social deviance is often a cover for the deeper, more pernicious, correlation between social class, stress, and both physical and mental dysfunction.
