As I suggested in the first essay in this series, our understanding of the four assumptive worlds of psychopathy can be informed by the differentiation to be made between paradigms, models and practices (the categorization developed by David Halliburton and myself). I suggested that assumptive worlds are composed of a few, very powerful paradigms, and a small cluster of models. Furthermore, the models are often borrowed from other fields—and as a result of this often-indiscriminate borrowing there are often untested and even inappropriate elements of the other field brought with this field.
We have seen this vividly demonstrated in the borrowing of theology and church dogma in the first assumptive world (spiritual aberration), the borrowing of spiritual, philosophical and cultural elements in the second assumptive world (distribution of energy, fluids and functions) and, finally, the borrowing of elements from the fields of sociology, history, sociopsychology and social criticism in the third assumptive world (social deviation).
This borrowing is even more poignant and pervasive in the fourth assumptive world. We observe an important shift from the social/political system in our third assumptive world to the medical system in the fourth world. With this shift comes the application of many medical terms, perspectives and treatment modalities to the domain that is now called “mental illness.” While there are many ways in which psychopathy has been confiscated by the world of medicine, I will focus on four major elements:
(1) the shifting to an external locus of control (we can usually trace psychopathy to a physiological dysfunction—often neurological in nature), with a secondary emphasis on internal locus of control (poor health habits)
(2) the belief that specific forms of psychopathy can readily be categorized (diagnosed) in a manner that leads to specific treatment strategies
(3) the effective treatment of specific psychopathologies usually requires a medical (typically pharmacological) intervention, and
(4) the payment for treatment is increasingly being aligned with medical reimbursement policies (“mental illness” is “covered” under a medical insurance plan or government-based financial support for “medical services.”)