The History of the Concept of Psychopathy
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Pratt, L. (August, 5, 2009). "Brain Difference in Psychopaths Identified" [Drawing].
Retrieved April 06,2014 from http://coyoteprime-runningcauseicantfly.blogspot.ca/2009/08/brain-difference-in-psychopaths.html


Dear Writer,
Thank you for selecting our group, we hope our research findings meet your expectations. The following study will explain how the historical outlook on psychopaths has been evolving from the 19th century up until now. Over the years, psychologists have created many different types of tests to determine if an individual is psychotic or not, which has created a substantial amount of controversy. Despite an extensive amount of research, the causes and triggers of psychopathy, whether biological or environmental, remain unknown. However, the more knowledge we gain by understanding their unique behaviour, the greater our chances become of successfully treating this mental disorder.
All the best,

Definition


Psychopathy is defined as a type of Antisocial Personality Disorder (APD), which is a chronic mental condition that distorts an individual’s ways of thinking. People with antisocial personality disorder often have dysfunctional relationships with others and have the tendency to manipulate people with their superficial charm and to behave impulsively or in some cases violently. Such individuals show no feelings of remorse or empathy; hence, they are unable to hold themselves responsible for their actions.

Clinic Staff. (April 12, 2013). Antisocial Personality Disorder. Definition. Retrieved March 28, 2014 from http://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/basics/definition/con-20027920


Historical Background

Early 19th Century

Pinel, P. (1962). A Treatise On Insanity (Facsim. of the London, 1806 ed.). New York: Hafner.

Before the 19th century, antisocial personality was not regarded as a clinical issue and was simply perceived as an issue within the mind, due to the common perception that a psychopath cannot reason properly. It was not until 1801, when a French physician named Philippe Pinel noted that many of his patients behaved in impulsive and self-damaging acts despite their capability to reason and grasp concepts rationally. He grouped these cases under the category manie sans délire (“insanity without delirium”). Until Pinel approached this psychopathological problem, it was assumed worldwide that mental disorders were specifically inhabited within the mind. As an individual's reason and intellect play a major role in determining unusual mental behaviour, and since these two components are closely connected to the mind, the common perception for all mental issues was associated with a perplexed mindset. However, Pinel suggested the notion that an individual can be identified as insane without confusion in the mind.

Prichard, J. C. (1835). A Treatise On Insanity and Other Disorders Affecting The Mind. London: Sherwood, Gilbert and Piper.

In 1835, British psychiatrist, J.C. Prichard, proposed the phrase “moral insanity” to label psychopathic behavior. He argued that such behavior indicated an inexcusable defect in character that deserved to be socially condemned. According to Prichard, people who lacked moral understanding are also incapable of making effective life decisions. They are easily convinced, despite their intelligence, by their own interests to engage in socially unacceptable behaviours. Prichard believes an individual’s mind or body is not physically harmed, but their temper and feelings are exhibited to the extent that they begin to have perverted and immoral thoughts as well as become largely dependent on others.


Late 19th Century

Millon, T. (2003). Psychopathy: Antisocial, Criminal and Violent Behaviour. New York: Guilford Press.

J.L. Koch suggested the notion that physiological changes, or physical attributes, contributed to psychopathic behaviour. Koch selected the term “psychopathic” in the 1890s to generally describe all personality disorders (this term was not defined as a specific disorder until recently). Koch proposed that the label “moral insanity” be replaced by the phrase “psychopathic inferiority”, which states that a person who lacks mental regularity will always remain psychopathic due to biological states and changes that are beyond the limits of physiological normality.

Krafft-Ebing proposed the increased involvement of sexual drives in psychopathy. Specifically referring to the male species, Krafft-Ebing stated that sadistic behaviour is rooted within normal male sexual impulses, hence aggressive inclinations are a natural part of their being. However, if these sadistic tendencies were found in a psychopath, they would be highly increased and may lead to the urgency to commit violent acts. Essentially, Krafft-Ebing believes that all humans have an innate desire to humiliate and hurt others, but this desire is intensified within psychopaths. Eventually, a psychopath's sadistic desires lead to violent acts that are often committed for little or no reason.


Early 20th Century

Millon, T. (2003). Psychopathy: Antisocial, Criminal and Violent Behaviour. New York: Guilford Press.

Freud suggested a notion concerning the character of psychopaths, with regard to his study of psychoanalysis. He referred to it as “criminality from a sense of guilt”, by which he meant that certain individuals commit crime or sociopathic acts because they are carrying an unknown oppressive guilt that triggers this need to exhibit criminal conduct. After committing this deed, this sense of guilt is immediately reduced. Freud states that this oppressive guilt is often associated with past events, which initiates psychopathic behaviour in certain individuals.

Mid 20th Century

Diagnostic and Statistical Manual of Mental Disorders (3d ed.). (1980). Washington, D.C.: American Psychiatric Association.

In 1952, the American Psychiatric Association dropped “psychopath” and officially adopted the new phrase, “sociopathic personality disturbance”. In 1968, the APA changed the 1952 classification to “personality disorder, antisocial type” The definition of a psychopath has been altered several times by the APA and many psychologists.

Cleckley, H. M. (1955). Mask of Sanity : An Attempt to Clarify Some Issues About the So Called Psychopathic Personality (3rd ed.). St. Louis: Mosby. pp. 238-255.

Psychopaths are defined by Hervey Cleckley as having superficial charm and highly skilled intellectual ability. Cleckley says that they initially come across as friendly, outgoing and educated individuals. They maintain excellent logical reasoning and can foresee the consequences of injudicious or antisocial acts. Psychopaths can strategically plan out a thorough outline of how they want to live their life. They have the ability to achieve success and happiness. However, Cleckley explains that psychopaths lack emotional reactions. While they may show anger or happiness, this is only effective mimicry; they do not actually experience these emotions. Cleckley describes psychopaths as individuals who have a disregard for truth and love, as they appear to have no internalized moral or ethical sense. They are unable to feel guilt after committing a harmful, inappropriate or criminal deed. Psychopaths lack insight for their own behaviour, which is demonstrated by their actions. This unsympathetic attitude is often demonstrated by a psychopath’s apparent assumption that legal penalties for a crime committed should not apply to him or her.


Late 20th Century

Kernberg, P. F. (1989). Narcissistic Personality disorder in Childhood. Psychiatric Clinics of North America, 12 (3), 671-94.

Otto Kernberg presented a hierarchical distinction of antisocial behavior, varying from the most to the least severely disordered. He specifically focuses on “malignant narcissism”, a personality pattern characterized by the following qualities:

  • Narcissistic personality disorder,
  • Antisocial behavior,
  • Sadistic behavior, to the extent that an individual commits self-harm or violence upon others,
  • and strong emotions of paranoia.

Additionally, Kernberg explains that the basic ego state of these individuals is emptiness, aloneness, disinterest in education, and a lack of short-term or long-term goals. Kernberg’s research on psychopathy was later considered and used by other psychologists, such as Robert Hare, to create effective methods of measuring, diagnosing and treating psychopaths.


The Biology and Neuroscience

Glenn, A. L., Raine, A., Schug, R. A., Gao, Y., & Granger, D. A. (2011). Increased Testosterone-to-Cortisol Ratio in Psychopathy. Journal of Abnormal Psychology, 120(2), 389-399.

There are biological causes in violators of social norms whose inability to feel remorse and empathy places them in the category of people with antisocial personality disorder (APD). The distinction between a normal individual and a psychopath will be in the interpersonal-affective characteristics such as: lack of guilt, dishonesty and fear. It has been seen that people with a history of violence have abnormal ratio of testosterone to cortisol levels that induce psychopathic traits. One study suggested that in families with more care and concern, the increased levels of cortisol in children consequently has reduced the aggressive behaviours in their futures as adults. However, another form of deviation from this hormonal ratio can lead to risky behaviours. For example, maternal smoking during prenatal development increases the chances of abnormal testosterone levels in the fetus which disturbs dominant and aggressive patterns in his future. Therefore, hormonal imbalances in APD patients cause impairment of brain normal functions. The following damages occur due to hormonal imbalances:

  • Prefrontal cortex damage,
  • Hippocampal asymmetry,
  • Amygdala deformation,
  • and an enlarged corpus callosum.

Raine, A. (2000). Reduced Prefrontal Gray Matter Volume and Reduced Autonomic Activity in Antisocial Personality Disorder. Archives of General Psychiatry, 57(2), 119-127.

The prefrontal cortex, on the anterior part of the brain's frontal lobes, and autonomic functions are crucial in experiencing emotions for guiding the appropriate cognitive behaviours and decision-making. The prefrontal cortex, as a part of our neural circuitry, plays an important role in development of the conscience, fear conditioning and evolving anticipatory responses. Reduced gray matter in prefrontal lobes show reduced autonomic activity in APD patients (Figure 1). Therefore, the APD patient’s inability in fear conditioning, reasoning and decision-making increases the risk for committing crime and violence.

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Figure 1: Measurement of gray and white matter volumes ,coronal (front) view, of the brain’s prefrontal cortex. MRI scanning showed that, APD patients have a volume reduction in the gray matter (S4), but not white matter (S6). As a result, a psychopath has reduced autonomic functions, which is important for a social emotional stressor.

Raine, A., Ishikawa, S. S., Arce, E., Lencz, T., Knuth, K. H., Bihrle, S., et al. (2004). Hippocampal Structural Asymmetry In Unsuccessful Psychopaths. Biological Psychiatry, 55(2), 185-191.

The use of MRI has revealed abnormal asymmetry in the hippocampus of people diagnosed with antisocial and violent behaviours. An abnormal hippocampus , located in the medial temporal lobe, has reduced left side but increased right side in violent offenders. The more neurons destroyed in the posterior hippocampus, the higher the impairment in fear conditioning. Hence psychopathic offenders fail to experience fear and normal emotional interaction that are both necessary for associative learning.

Yang, Y., Raine, A., Narr, K. L., Colletti, P., & Toga, A. W. (2009). Localization Of Deformations Within The Amygdala In Individuals With Psychopathy. Archives of General Psychiatry, 66(9), 986-94.

The amygdala plays a significant role in the formation of emotions, rationality and social behaviours. Psychopathic individuals show significant deformation of the amygdala. The bilateral volume reduction contributes to emotional dysfunction, unusual behaviours in response to threats and lack of remorse. Fear conditioning and a sense of guilt is exceptionally important in the development of moral values in social interactions and withdrawal conduct during the times of agony and fear.

Raine, A. (2003). Corpus Callosum Abnormalities In Psychopathic Antisocial Individuals. Archives of General Psychiatry, 60(11), 1134-42.

The other structural difference between a normal individual and an APD patient is an enlarged corpus callosum. The corpus callosum consists of neural fibers important in connecting the brain’s hemispheres. After being assessed by an MRI device, psychopathic offenders and criminals showed an increase in white matter substance which constructs the corpus callosum body as a whole. This abnormality lowers autonomic functions crucial in regulating the rate of aggressive behaviours and feelings of empathy.


History of the Measurement

Wolfgang, M. E. (1961). Pioneers in Criminology: Cesare Lombroso (1825-1909). J. Crim. L. Criminology & Police Sci., 52 (4), 361-91.

Cesare Lombroso, a forensic psychiatrist, is known as the father of criminology, who believes that criminals are born, not made. During the nineteenth century, an emphasis was put on understanding the relationship between criminology and natural sciences, as Lombroso had many theories regarding why individuals act in a certain way. He relied on physical characteristics, such as the size of one's skull, colour of their skin, and the development of their jaw, in determining who is and is not a criminal. Furthermore, he went as far as to claim that he could even figure out what types of crimes they could potentially commit, which raised great controversy.

Saxe, D. B. (January 01, 1971). Psychiatry sociopathy and the XYY Chromosome Syndrome. Journal of Forensic Medicine, 6(3), 243-55.

XXY Theory

This theory states that criminals have an extra Y chromosome, which instils in psychopaths a stronger urge to commit crimes. In lawsuit cases decades ago, many lawyers used this genetic evidence to prove that the defendant should not be held accountable because they lacked control over their actions.

Mental Disorders. (January 29,2001). Hare Psychopathy Checklist. Retrieved March 28, 2014 from http://www.minddisorders.com/Flu-Inv/Hare-Psychopathy-Checklist.html#ixzz2VY2BrSPx

PCL-R

The PCL-R is one of the most famous and widespread tools in measuring if someone is a psychopath. This checklist was created by Robert Hare, and has been used since the 1980’s. Highly trained psychologists use this questionnaire to assess psychopathic traits in an individual. There are two ways that this assessment can be completed, the first would be an interview of 125 questions, along with information from certain documents. Another way to complete this assessment, is based solely on any forensic psychotic record of an individual. Each item has a score of up to two points, and if you score a 30 or higher, you are considered a psychopath.

The PCL-R includes 20 items, which are personality traits that are very common among psychopaths. According to Hare, if an individual shows a high probability (scores 30 or more) of containing any of these features, they are most likely a psychopath. The following 20 constructs are used in the PCL-R scale to judge psychopaths:

1. Superficial charm
2. Extreme sense of self-worth
3. Need for exciting stimulation or proneness to boredom
4. Pathological lying
5. Conning and manipulativeness
6. Lack of remorse or guilt
7. Shallow affect
8. Cold-hearted and lack of empathy
9. Parasitic lifestyle
10. Poor behavioural controls
11. Promiscuous sexual behaviour
12. Early behaviour problems
13. Lack of realistic, long-term goals
14. Impulsivity
15. Irresponsibility
16. Failure to accept responsibility for own actions
17. Many short-term marital relationships
18. Juvenile delinquency
19. Revocation of conditional release
20. Criminal versatility

The Psychopathic Personality Inventory

The Psychopathic Personality Inventory, unlike the PCL-R, is a self-report measurement tool. It consists of 187 items, which provides a score for each sub-scale. Some of the sub-scales include social potency (ability to seem charming), cold-heartedness, stress immunity, and so forth. This type of measurement was also developed by Robert Hare, and focused on certain aspects of an individual’s personality.

Frick, P. J., & Hare, R. D. (2001). Antisocial Process Screening Device: APSD. Toronto: Multi-Health Systems.

Measures of psychopathic traits in children and adolescents

The Antisocial Process Screening (APS) device is made up of 20 items used to measure psychopathy in children and adolescents. Personality traits like extreme violence and defiance against rules are most often linked to psychopathy. This form of measurement is aimed at children between the ages of 6-13, with the hopes of preventing psychopathic characteristics from leading to actions of violence and crime. Authority figures, such as parents and teachers, have the responsibility to rate a certain individual based on their behaviour.


History of the Treatment

Decades ago

Bourne, R. (2010). Antisocial Personality Disorder: The NICE Guideline On Treatment, Management And Prevention.The British Journal of Psychiatry, 197(4), 337.

Bourne’s teaching experiences provided him with the foundation to do extensive research on APD patients by consulting with criminologists, sociologists, and psychologists. The National Collaborating Centre for Mental Health has published a study focusing on available treatments for psychopaths in the past few decades. It explains how people have dealt with psychopaths when no medicine, or other methods of treatment, were available. He explains that in earlier times, psychopaths were being treated through wrong approaches such as late interventions, use of electric shocks and imprisonment.

Present Day

Lee, J. H. (1999). The Treatment of Psychopathic and Antisocial Personality Disorders: A Review. Clinical Decision Making Support Unit, Broadmoor Hospital, Berkshire.

This scholarly journal written by Jessica Lee, a forensic psychiatrist, is an in-depth look at available treatments for psychopaths nowadays. She mentions that the treatment for patients can take place in a variety of settings. This includes special hospitals, regional secure units, or intensive psychiatric care units. She explains the advantages and the disadvantages associated with each of these institutions. Lee introduces different approaches that may be used to treat psychopaths and the effects of each on patients. Some examples include pharmacological approaches, behaviour therapy, and cognitive approaches. She explains that the most common approach is pharmacological treatment, which consists of using different medications such as neuroleptics, antidepressants, lithium, benzodiazepines, and psychostimulants. She also indicates the pros and cons associated with each of the approaches in treating psychopaths. She then continues to the four treatment models that are currently being used by the following institutions: the Henderson hospital, the Woodstock Ward Broadmoor hospital, Dr Henri Van Der Hoeven Clinic, and the HMP Grendon Underwood. The Henderson hospital was established after World War II and it pioneered a patient-oriented approach in psychopathic treatment. Art therapy, psychodrama, and task-centred group works were some strategies used in this hospital. The Woodstock Ward Broadmoor Hospital used group therapy and daily medication as its primary form of treatment. Dr Henri van Hoeven Clinic uses group psychotherapy, combined with rehabilitation and resocialization programs, to assist psychopaths. HMP Grendon Underwood takes a maximum security prison approach, along with educational services, in treating criminal psychopaths. The goal of the system is to help patients learn how to connect and interact with others and better handle responsibilities. The Woodstock ward Broadmoor hospital approach is a highly recommended form of treatment that many psychologists continue to use today. Lastly, Lee explains that a patient’s unwillingness to cooperate or interact with their doctor is the most common reason for obstacles to be presented during treatments. Therefore, he encourages that psychotherapists continue to follow professional procedures that are scientifically proven to ensure a successful treatment.


Nature Vs. Nurture Debate

Hutchings, B., John Hopkins University Press Baltimore., & Mednick, S. (1977). Registered Criminality in the Adoptive and Biological Parents of Registered Male Criminal Adoptees. New York: United States 1975.

In the Hutchings and Mednick (1977) study, a sample of 14,427 male and female adoptees from Denmark were entered into an analysis to judge whether or not biological components played a role in exhibiting criminal or antisocial behavior. The final study was narrowed down to 4,065 adopted males, as males seemed to suggest a higher tendency to commit criminal acts. The researchers asked the children to live with both their biological and adopted parents in order for them to observe which parents influenced them the most. They found that crime is a sociological concept, and although the genetic component may play a part in the cognitive makeup of the individual, environmental and socioeconomic factors influence people the most. A negative environment often leads to mental disorders, such as substance abuse and psychopathy.

Mitchell, C.M., (2012). A Tale of Two Psychopathys: Paradigm Shift for Psychopathy. Ann Arbor: ProQuest.

Cindy Michelle Mitchell studied two different psychopathic behaviours: Psychopathic Personality Disorder and Antisocial Personality Disorder. She defines traits that represent Psychopathic Personality Disorder as "Factor 1" characteristics and traits representing Antisocial Personality Disorder as "Factor 2". Several environmental elements have been identified as contributing to antisocial behavior in both adults and children such as: socioeconomic status, abuse, parental substance use, neglect, and interfamilial conflicts. Researchers have conducted many studies looking at environmental impacts on the two factors of psychopathy. These investigations have shown that different environmental risks have a unique relationship with both Psychopathic Personality Disorder and Antisocial Personality Disorder. It is possible that an individual's socio-economic status has a direct impact, though it is more likely that a low socio-economic status contributes to other risk factors, which together put a person at a higher risk. One factor that can be related to lowered socio-economic status is family history of criminal behaviors, which continuously demonstrates a high association with future psychopathy in the person, especially if he had a parent who was also a psychopath. In this case, psychopathy may result from genetics, growing up in an antisocial environment, or as is most likely the case, a combination of both.


Social Stigma and Legal Judgment

Psychopaths and Social Stigma

Kurzban, R., & Leary, M. R. (2001). Evolutionary Origins Of Stigmatization: The Functions Of Social Exclusion. Psychological Bulletin, 127(2), 187-208.

The public generally associates the psychopath with criminality. Isolation and avoidance are common reactions to those with mental illnesses, including psychopaths. Mental patients are often associated with dysfunctional behaviors such as violence, unpredictability, or even moral depravity. This is the general stigmatization psychopaths often encounter. Their stigmatization occurs in four stages:

  • Labelling: mentally ill are usually labelled as deficient and simple-minded by common people.
  • Negative Stereotyping: thoughts that may be adopted about the mentally ill that may or may not accurately reflect reality e.g. always being dangerous.
  • Segregation: the isolation of individual and those close to the mentally ill from the society and normal social interactions.
  • Discrimination and loss of status: the active exclusion of the mentally ill from social circles, institutions, or society as a whole.

González-Torres, M. A., Oraa, R., Arístegui, M., Fernández-Rivas, A., & Guimon, J. (2007). Stigma And Discrimination Towards People With Schizophrenia And Their Family Members. Social Psychiatry and Psychiatric Epidemiology, 42(1), 14-23.

Patients with mental diseases tend to experience many of these stigmatizations in life. They often attempt to isolate and limit their presence or interactions in society. This is perhaps a defense mechanism that develops in order to avoid rejection and to reduce emotional sufferings. Mentally ill patients form an overprotective attitude that may contribute to their inability to function as independent members of society.

Those who were told that genetics played the main role in the formation of mental disorders were more prone to increase their social distance from the mentally ill, compared to those who were told that the illnesses can be explained by social and environmental factors. In other words, they assumed that all genetic-based APD patients were dangerous; hence, their possible violent actions would be more harmful and incurable. Furthermore, those who were informed of the genetic basis of this disorder were also more likely to stigmatize the entire family of an APD individual to be dysfunctional too. The social categories that become stigmatized can vary over time and place. The three basic forms of stigma are physical deformity, poor personal traits, and tribal out-group status. These are found in most cultures and eras, causing some researchers to hypothesize that the tendency to stigmatize may have evolutionary roots.

Damasio, A. R. (2003). Ever since feelings. Looking for Spinoza: Ioy, Sorrow, and the Feeling Brain. Orlando, Fla.: Harcourt.pp. pp. 153-54.

In "Looking for Spinoza", Damasio describes one psychopathic patient who is unresponsive to social cues. As a result, she drops out of school and becomes pregnant at a young age. Moreover, she usually faced trouble with the law because of her inability to understand the risks involved with her actions. When she participated in risky behaviours she gave off the impression of an inattentive and undisciplined child, not an individual requiring psychological help. This is an example of the typical characteristics a psychopath would portray, in regard to their lack of social emotions and neglect of laws or regulations.


Legality of Psychopaths

Campbell, E. (1990). Psychopath and the Definition of Mental Disease or Defect under the Model Penal Code Test of Insanity: A Question of Psychology or a Question of Law. The. Neb. L. Rev., 69, 190.

If we claim psychopaths are mentally ill and incapable of understanding the consequences of their actions, can we then hold them legally responsible? Not necessarily, but depending on their criminal acts, there are special facilities designated which could be useful to utilize for such cases. This includes prisons and psychological institutions, which help restrain their interaction with society as a whole. Sexual predators are deemed psychopaths, and the legal system has established a specific set of rules to deal with their crimes.

In the United States, people diagnosed with psychopathy are subject to the "Involuntary Treatment Act". Under this act, mentally ill individuals and sexual predators, who the court deems a danger to themselves and others, receive involuntary treatment. Involuntary treatment refers to medical treatment undertaken without a person's consent. In almost all circumstances, involuntary treatment is psychiatric treatment given to an individual even if they protest. In this regard, the legal statute states:

"Sexually violent predators generally have antisocial personality features which are amenable to existing mental illness treatment modalities…. The legislature further finds that the prognosis for curing sexually violent predators is poor, the treatment needs of this population are very long, and the treatment modalities for this population are very different from the traditional treatment modalities for people appropriate for commitment under the Involuntary Treatment Act" (Wash Laws 71-09-010 (1990)).

Schwartz, B. K. (2000). Dangerous Sex Offenders: A Task Force Report of the American Psychiatric Association. Psychiatric Services, 51(10), 1322-a-1323. Retrieved March 6, 2014, from the Brit. Jour. of Psychiatry. database.

Programs for the mentally ill in the United States were aimed primarily, if not exclusively, towards sex offenders. Sex offenders were deemed the most heinous criminals. As such, they received countless laws of their own. Many laws, although varying between states, were based upon the idea of being in a state of emotional unstableness, demonstrating impulsive behaviour, lacking appropriate judgment, failing to appreciate the consequences of one’s own actions,or a combination of any such conditions. These traits would render a person irresponsible for their conduct with respect to sexual matters and thereby make the individual dangerous to others. Many psychopaths, who are deemed sex offenders, would almost always receive lengthy and indefinite prison sentences.

In the 1990s, the American Psychiatric Association slammed these laws for their use of psychiatric commitment as a ‘‘pretext for extended confinement that would otherwise be impermissible’’ . The APA said that these laws distort the traditional meanings of civil commitment, misallocate psychiatric facilities and resources, and constitute an abuse of psychiatry.


Case Study

Ellison, Chris (2013). Psychopath Night [video file documentary]. Published by Channel 4. Retrieved from: https://www.youtube.com/watch?v=pROu77TvZzA

The following video is a documentary created by Channel4 named "Psychopath Night". It unravels the mystery of Charles Albright mind, a psychopath famously recognized as "The Eyeball Killer". He was born in Texas and was adopted from an orphanage. As a child, he began killing small animals but later in his life, he became obsessed with human eye balls and started killing and removing the eyes of his victims. He is believed to have carried out at least three murders without any traces of remorse or empathy.

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