Tackling psychopathy: a necessary competency in leadership development?

Prasanna de Silva BMedBiol, MRCPsych – Progress in Neurology and Psychiatry September/October 2014

In the second of his two reflections on the Francis Report, Dr de Silva discusses the culture of workplace bullying and the role of a leader in addressing associated psychopathy in the National Health Service.

Following the public inquiry into events at Mid Staffordshire National Health Service (NHS) Foundation Trust in 2013, the Francis Report described a cul-ture of endemic bullying, where whistle-blowers were persecuted by management, whose focus was on achieving Foundation Trust status instead of patient safety and quality of care. Francis also suggested that this culture probably existed across the NHS.

These comments are consistent with a previous national survey in 2007 of trainee doctors

and the opinions of Sir Ian Kennedy on leaving the Healthcare Commission in 2009, including his reflections on the Bristol heart surgery scandal.

Financial costs include ill health and severance payments, litigation following accidents, and damages awarded by industrial tribunals.

Description of psychopathy

Psychopathy was described initially by Cleckley in 1941. Core features as defined by Hare include a tendency to manipulate others, being unable to empathise with other’s feelings, having no remorse, and being unable to say sorry despite clear evidence of wrongdoing or distress to others.

Other authors have described life-long psychopathic traits only evident when the individual is under pressure to perform in a social or workplace setting. A concept of a ‘proto-psychopath’ has also been described: someone who exhibits psychopathic behaviour only in a work setting. These behaviours could be modelled on a psychopathic individual further up the hierarchy, who appears to thrive in the organisation.

Most epidemiological surveys utilising operational criteria of psychopathy have suggested that the overall rate of this condition is less than 1% of the population.

However, it is recognised that this is an underestimate of prevalence in organisations, with rates up to 1 in 25 among managers and senior employees. Therefore, most adults would have worked with – or been supervised by – a psychopathic individual. Psychopathic organisations have also been described;

these tolerate psychopathic behaviour among senior employees, while exhorting staff lower down the hierarchy to abide strictly by organisational values.


These organisations typically tend to concentrate on self-promotion, rather than on self-scrutiny and admissions of failures.

Psychopaths in health care can cause lost productivity due to low morale, sickness and safety failures.

Patients lacking in capacity could suffer due to rash treatment. If junior staff lack the courage to question a psychopathic line manager or senior, safety warnings can go


Careers of individuals expressing disquiet or ‘whistle-blowing’ about conduct within a department are also at risk. A psychopathic individual who feels threatened will plan career destruction of the ‘complainant’ by starting false rumours or reporting fictitious errors.

How to spot a psychopathic individual at work workplace bullying by a senior colleague is probably the best indirect indicator of psychopathy, although care needs to be taken as this might also reflect failings on the part of the ‘victim’. Another indirect indicator would be sickness rates, although inadequate resources to carry out the work need to be kept in mind.

Read the full article here http://onlinelibrary.wiley.com/doi/10.1002/pnp.344/pdf


For further reading on psychopaths – there has been an interesting article published in the Telegraph April 2014


Anders Breivik, the Norwegian gunman who killed 77 people in a bomb and shooting rampage in 2011

There are a few things we take for granted in social interactions with people. We presume that we see the world in roughly the same way, that we all know certain basic facts, that words mean the same things to you as they do to me. And we assume that we have pretty similar ideas of right and wrong.

But for a small – but not that small – subset of the population, things are very different. These people lack remorse and empathy and feel emotion only shallowly. In extreme cases, they might not care whether you live or die. These people are called psychopaths. Some of them are violent criminals, murderers. But by no means all.

Professor Robert Hare is a criminal psychologist, and the creator of the PCL-R, a psychological assessment used to determine whether someone is a psychopath. For decades, he has studied people with psychopathy, and worked with them, in prisons and elsewhere. “It stuns me, as much as it did when I started 40 years ago, that it is possible to have people who are so emotionally disconnected that they can function as if other people are objects to be manipulated and destroyed without any concern,” he says.