1 minute ago, studiot said:

Thanks so the issue is much wider than just the patient.

How does society ensure that the 'right' sort of person or persons makes the decision ?

How far should the patient's wishes be considered ?

If the patient's wishes are to be overridden, who will be there to see that the aptient's interests are served ?

Given my OP and what @TheVat said - should anyone decide at all?

The option for a voluntary change should be available and working on it is a necessity IMO. But deciding for somebody else is a different matter.

57 minutes ago, TheVat said:

If they score high on the HC, and start slaughtering the neighbor's dogs who disturb their beauty sleep, and the teenagers are next on their list, then that's a different situation where criminal justice comes onto play.

But there's a serious ethical dilemma here. Do we wait for violence to occur before we act even when we strongly suspect it’s coming? If we always wait until someone is harmed, we risk failing the victims who could've been saved, the damage is irreversible. Let's say there weren't any clear and early warning signs like killing the neighbor's dog, then who gets to decide what counts as a threat? How do we go about resolving this without crossing into the line of punishing someone for having a mental illness?

Just now, DavidWahl said:

But there's a serious ethical dilemma here. Do we wait for violence to occur before we act even when we strongly suspect it’s coming? If we always wait until someone is harmed, we risk failing the victims who could've been saved, the damage is irreversible. Let's say there weren't any clear and early warning signs like killing the neighbor's dog, then who gets to decide what counts as a threat? How do we go about resolving this without crossing into the line of punishing someone for having a mental illness?

I agree there is a serious ethical dilemma. +1

Not just for thos edirectly involved but also for those who employ them or are in charge of them.

Compare this situation with prison warders and prison governors and the prisoners themselves.

Very similar ethical dilemmas exist here too.

And how about soldiers with PTSD ?

This whole thing runs wider in our society.

42 minutes ago, DavidWahl said:

But there's a serious ethical dilemma here. Do we wait for violence to occur before we act even when we strongly suspect it’s coming? If we always wait until someone is harmed, we risk failing the victims who could've been saved, the damage is irreversible. Let's say there weren't any clear and early warning signs like killing the neighbor's dog, then who gets to decide what counts as a threat? How do we go about resolving this without crossing into the line of punishing someone for having a mental illness?

This dilemma presupposes that whatever trait under discussion is highly predictive for violence and related actions. The issue starts already with the classification as mentioned earlier in this thread. Even a term such as Antisocial Personality Disorder is not specific but describes broad patterns. Among those diagnosed with APD, only about 30% have traits that align with what is called sociopathy (e.g., only bonding with primary group, high impulsiveness, higher likelihood of violent outburst, morality often limited to to primary group), which is likely associated with environmental factors, such as adverse childhood experiences. Only a small subsection of the folks diagnosed with APD, have are aligned to what OP seemingly refers to as psychopathy traits (including lack of bonding, insensitivity to pain or suffering of others, even as children, lack of guilt or remorse). So it is a very small and AFAIK not clearly defined group of people. Depending on the criteria, some studies have found successful leaders with psychopathic tendencies (though some early studies suggesting that psychopathy is positively correlated with success in corporate leadership is probably overblown).

While violence is more common in psychopaths, I have seen figure of around 2x more likely, the likelihood of men conducting violence compared to women is also around that order of magnitude. So just that does not seem to me as a sufficient indicator for broad intervention (or at least we do not seem to really contemplate treating all men). The question is then whether there is a way to identify those most at risk for selective treatment, if such a thing was available.

1 hour ago, CharonY said:

This dilemma presupposes that whatever trait under discussion is highly predictive for violence and related actions. The issue starts already with the classification as mentioned earlier in this thread. Even a term such as Antisocial Personality Disorder is not specific but describes broad patterns. Among those diagnosed with APD, only about 30% have traits that align with what is called sociopathy (e.g., only bonding with primary group, high impulsiveness, higher likelihood of violent outburst, morality often limited to to primary group), which is likely associated with environmental factors, such as adverse childhood experiences. Only a small subsection of the folks diagnosed with APD, have are aligned to what OP seemingly refers to as psychopathy traits (including lack of bonding, insensitivity to pain or suffering of others, even as children, lack of guilt or remorse). So it is a very small and AFAIK not clearly defined group of people. Depending on the criteria, some studies have found successful leaders with psychopathic tendencies (though some early studies suggesting that psychopathy is positively correlated with success in corporate leadership is probably overblown).

While violence is more common in psychopaths, I have seen figure of around 2x more likely, the likelihood of men conducting violence compared to women is also around that order of magnitude. So just that does not seem to me as a sufficient indicator for broad intervention (or at least we do not seem to really contemplate treating all men). The question is then whether there is a way to identify those most at risk for selective treatment, if such a thing was available.

Eloquently expressed.

If we can't determine objectively (in a way broader society would accept as fair and reasonable) who might warrant pre-emptive intervention, and we don't in any case have the treatments, I'm not sure what there is to discuss.

Would it make sense to forcibly cure psychopaths if the tools were available?

Have you seen A Clockwork Orange?

16 hours ago, Otto Kretschmer said:

The core problem of psychopathy is that it comes with complete lack of guilt or remorse as well as lack of fear, sadness and profound egocentricity - their condition doesn't cause them any suffering so they don't feel broken and thus, do not generally want to change. Some actually view their lack of empathy as an asset that helps them succeed in life.

It’s not a problem, it’s simply how they are neurologically wired

Psychopaths do not feel remorse, they are not inherently bad, or good. Nor are they inherently violent etc

Saying you would “forcefully cure” them is somewhat similar to saying you can cure someone of autism, you can’t really forcefully utilize a method of treatment onto someone with a neurological condition.

Edited July 25Jul 25 by Sohan Lalwani

4 hours ago, Sohan Lalwani said:

It’s not a problem, it’s simply how they are neurologically wired

Psychopaths do not feel remorse, they are not inherently bad, or good. Nor are they inherently violent etc

Saying you would “forcefully cure” them is somewhat similar to saying you can cure someone of autism, you can’t really forcefully utilize a method of treatment onto someone with a neurological condition.

Besides, where else would we find useful soldier's (heroes)?

The topic has a very "A Brave New World" type vibe...

Edited July 25Jul 25 by dimreepr

1 hour ago, dimreepr said:

Besides, where else would we find useful soldier's (heroes)?

The topic has a very "A Brave New World" type vibe...

People with ASPD would actually make poor soldiers.

They are psychologically resilient and calm under pressure but also extremely egocentric - military career requires years of self improvement and learning from others - and it's hard to listen to other people when you already consider yourself far superior to others. The smarter ones would probably not even consider joining the military, the would prefer a career in business or politics both of which are much more lucrative and far less dangerous.

Edited July 25Jul 25 by Otto Kretschmer

23 hours ago, Otto Kretschmer said:

Simply because the name psychopathy is no longer used in diagnostic textbooks doesn't mean that the specific traits are not present in the population. You may call the Earth a gas giant but you'll never turn it into one.

In DSM-5 here is the diagnostic unit called Antisocial Personality Disorder: https://en.wikipedia.org/wiki/Antisocial_personality_disorder#Treatment

In ICD-11 ASPD does not function as an independent diagnostic unit but it's symptoms are covered under Dissociality trait domain under the general diagnosis of Personality Disorder.

So this specific constellation of traits does exist and it is considered maladaptive, it's simply covered under different names.

But the traits represent a spectrum rather than a binary condition - a lot of people probably exhibit the traits to some degree, from time to time. Is there a non-arbitrary way you draw the line?

There’s also a lot of mentions of “likely” to act certain ways, meaning that it’s not a certainty that anyone with these traits actually breaks any law. The link says “People with ASPD often exhibit behavior that conflicts with social norms” so basically you would be “treating” people for being different, which is a very dangerous approach and one that’s been abused in the past, and being abused today.

1 minute ago, swansont said:

But the traits represent a spectrum rather than a binary condition - a lot of people probably exhibit the traits to some degree, from time to time. Is there a non-arbitrary way you draw the line?

There’s also a lot of mentions of “likely” to act certain ways, meaning that it’s not a certainty that anyone with these traits actually breaks any law. The link says “People with ASPD often exhibit behavior that conflicts with social norms” so basically you would be “treating” people for being different, which is a very dangerous approach and one that’s been abused in the past, and being abused today.

Yes, it is indeed a spectrum and this fact impacts be personally and not in a positive way - I am myself likely at the lower (though not extremely low) end of the empathy spectrum and likely due to heredity - my grandfather was kicked out of his house by his brothers after having chased his mother with an axe (they said if he shows up again, they are going to kill him, he died in 2021 due to COVID, aged 93). I myself have a history of trying to burn a cat alive at age 4 and killing two birds at age 5 as well as trying to make a cat kill a hamster also at age 5. I am not antisocial and I'm pleasant to interact with, I can also be altruistic in a genuine way but I am simpyl not fully content with myself. :( Especially that it comes together with high Neuroticism.

While I am not a proponnt of forceful treatment, I think that people on the extremely low end of the empathy/altruism spectrum are missing out a lot. Their state is not a minor inconvienance, they are missing arguably the most important thing that makes humans human - the ability to emotionally connect with people and the world. They don't experience the joy of falling in love, seeing friends or family members succeed or having the government enact a just, progressive policy. For them humans are just tools to be used and discarded, no more important than a piece of toilet paper.

Edited July 25Jul 25 by Otto Kretschmer

Just now, Otto Kretschmer said:

Yes, it is indeed a spectrum and this fact impacts be personally and not in a positive way - I am myself likely at the lower (though not extremely low) end of the empathy spectrum and likely due to heredity - my grandfather was kicked out of his house by his brothers after having chased his mother with an axe (they said if he shows up again, they are going to kill him, he died in 2021 due to COVID, aged 93). I myself have a history of trying to burn a cat alive at age 4 and killing two birds at age 5 as well as trying to make a cat kill a hamster also at age 5. I am not antisocial and I'm pleasant to interact with, I can also be altruistic in a genuine way but I am simpyl not fully content with myself. :( Especially that it comes together with high Neuroticism.

While I am not a proponnt of forceful treatment, I think that people on the extremely low end of the empathy/altruism spectrum are missing out a lot. Their state is not a minor inconvienance, they are missing arguably the most important thing that makes humans human - the ability to emotionally connect with people and the world. They don't experience the joy of falling in love, seeing friends or family members succeed or having the government enact a just, progressive policy. For them humans are just tools to be used and discarded, no more important than a piece of toilet paper.

Well it sounds like you have progressed a long way forwards if you can recognise all this in yourself.

+1

9 minutes ago, studiot said:

Well it sounds like you have progressed a long way forwards if you can recognise all this in yourself.

+1

I have never really harmed anyone in my life. I have had friends and all my family members like me. I also see a lot of positive traits in myself, including literally boundless intellectual curiosity and good logical thinking but that's a different story and really off topic. :)

Mental health and cognition are my main drivers of my interest in gut microbiome research since it is a potential factor and very possibly a significant one but I am digressing

Edited July 25Jul 25 by Otto Kretschmer

21 hours ago, DavidWahl said:

But there's a serious ethical dilemma here. Do we wait for violence to occur before we act even when we strongly suspect it’s coming? If we always wait until someone is harmed, we risk failing the victims who could've been saved, the damage is irreversible. Let's say there weren't any clear and early warning signs like killing the neighbor's dog, then who gets to decide what counts as a threat? How do we go about resolving this without crossing into the line of punishing someone for having a mental illness?

That was not the legal dilemma my post was addressing. I was giving the example of someone actually doing a criminal act (killing pets) and that was simply one example. I wasn't proposing that people be arrested for Maybe Will Kill Teenagers, when they've committed the animal killing. My point was that ASPD, when it manifests in harm of some kind, would be responded to as any such behavior, with legal penalties. If, while incarcerated, a prison psychiatrist makes a finding of ASPD, then that would become a factor to consider at a parole hearing - especially if the perpetrator did not express remorse for their actions, or showed antisocial behavior with respect to other prisoners. So, no, not a fan of Phil Dickian "pre-crime" enforcement.

10 hours ago, KJW said:

Have you seen A Clockwork Orange?

That film came immediately to mind when I started following this thread.

5 hours ago, dimreepr said:

The topic has a very "A Brave New World" type vibe...

I do strongly agree here, I understand it’s a question from OP but I can’t really understand the intention

1 hour ago, Otto Kretschmer said:

While I am not a proponnt of forceful treatment, I think that people on the extremely low end of the empathy/altruism spectrum are missing out a lot.

But the thread is about forced treatment, according to the title. Your own story sounds like you being aware of the situation has helped, and might be about whether voluntary treatment is an avenue.

It also points toward actual actions being the thing to respond to, rather than just having the disorder/condition. It’s also IMO an argument for treatment/rehabilitation being available rather than just punishment for actions.

On 7/24/2025 at 10:54 AM, Phi for All said:

Forcibly curing an adult of anything is a real battlefield ethically. Who is the judge of when the behavior requires force? Which medical professionals are calling for the use of force?

On 7/24/2025 at 12:07 PM, studiot said:

I wonder if you have any idea at all of what a doctor goes through when treating a patient necessitates damaging them in some way ?

These are the wrong metrics to use when this type of decision is necessary.
If the harm they can do to themselves or society is greater than the 'damage' done to them, then the 'treatment' may be necessary.

This is controversial because mental conditions are what make us who/what we are, and some people would extend this to other 'mental conditions' outside the 'normal' ( if psychopathy, why not sexual preference ? ), so I generally don't agree with such 'treatment'.
But I can see the need for such in cases, for example, where a person may be cutting, or otherwise damaging, themselves, due to mental instability, or taking street people into shelters against their will in -30^o winter conditions.

However, this idea is more easily understood if we were to use a physical condition, other than mental, such as infectious diseases like COVID, I, and most other members of this forum, would agree that vaccination be mandatory, to prevent harm to self and society.
Even if it has the potential to cause a very small percentage of adverse effects.

Just now, MigL said:

These are the wrong metrics to use when this type of decision is necessary.

I didn't say or mean it was a 'metric'.

My question stands regardless.

13 hours ago, TheVat said:

That was not the legal dilemma my post was addressing. I was giving the example of someone actually doing a criminal act (killing pets) and that was simply one example. I wasn't proposing that people be arrested for Maybe Will Kill Teenagers, when they've committed the animal killing. My point was that ASPD, when it manifests in harm of some kind, would be responded to as any such behavior, with legal penalties. If, while incarcerated, a prison psychiatrist makes a finding of ASPD, then that would become a factor to consider at a parole hearing - especially if the perpetrator did not express remorse for their actions, or showed antisocial behavior with respect to other prisoners.

I agree that once actual harm has occurred, it makes sense for traits like ASPD to be considered in sentencing or parole. But I’m still troubled by the question: What do we do when someone shows deeply concerning signs before any actual harm is done? There was a recent case of a teenage boy who created horrifying, disturbing drawings fantasising about murder and later went on to actually murder someone. His father noticed the signs prior to the event but didn’t act likely out of fear of overreacting. Was it right for society to wait? As @studiot also suggested, this issue is far more complex and nuanced than it may first appear. It runs deeper into society. It's not as simple as saying, 'Act only after harm is done,' or 'Don't criminalize traits.' We're dealing with difficult questions now about how to respond to warning signs that don’t yet qualify as crimes but may indicate serious risk.

13 hours ago, TheVat said:

So, no, not a fan of Phil Dickian "pre-crime" enforcement.

I'm not in favor of pre-crime punishment either but I believe we should at least have a preventive system that allows for early support or intervention when someone shows credible signs of dangerous intent. That way we could protect others without criminalizing mental illness. This is the grey area I believe we need to take seriously.

By the way, some conscious genetic sculpting of society is already taking place, albeit at an earlier stage - in Denmark genetic screening for Down syndrome is universal and over 90% of embryos with Down syndrome are aborted. This might expand to other disorders in the future.

18 hours ago, Otto Kretschmer said:

By the way, some conscious genetic sculpting of society is already taking place, albeit at an earlier stage - in Denmark genetic screening for Down syndrome is universal and over 90% of embryos with Down syndrome are aborted. This might expand to other disorders in the future.

In cases like this, ethics is the acceptable face of a moral deviation; a very slippery slope...

On 7/25/2025 at 8:22 PM, studiot said:

I didn't say or mean it was a 'metric'.

My question stands regardless.

Indeed, who are we to demand the doctor's damage themselves, for us?

"The risk Socrates himself faces is obvious but, as he explains it, the danger he faces is far less grave than the one the jurors may inflict upon themselves: Rest assured that if you kill me – since I am the person I say I am – you wouldn't harm me more than you harm yourselves."

The ethical issue involved is, of course, patient autonomy. Thus in order to compel treatment the patient must be unable to exercise their autonomy, typically either becsuse they are incompetent or, in this case, if the state has assumed control of their medical decision making. Such as with Typhoid Mary or when rapists are offered Depo-Provera treatment (emphasis on "offered").

Edited August 3Aug 3 by LuckyR

It doesn't seem more ethically problematic than what is done routinely to convicted criminals to me - which often includes physical and psychological torture as well as forced labour. It is usually intended to teach a lesson ie change thinking and behavior in ways not so different than A Clockwork Orange - ie crude and unscientific application of aversion therapy. In some cases that works, although I think it sometimes makes future behavior worse.

In some jurisdictions agreeing to undergo some kind of behavior changing therapy is an alternative to imprisonment or gets reduced sentences. It may be presented as a choice although perhaps too often of the can't refuse sort of volunteering.

Applied pre-emptively by court order or some other kind of forced gets more ethically problematic but post-conviction for crime? It seems to me criminal justice systems have never been much concerned with the ethics of criminal justice systems.

Edited August 3Aug 3 by Ken Fabian

The issue with ASPD folks is that they simply don't feel broken at all. Humans need to feel bad becuase of their actions in order to feel the need for change, ASPD people don't feel that. This is due to two things:

• Their amygdala is severely underactive. This causes a profound lack of fear, sadness, guilt, remorse etc.

• The amygdala-PFC connection is broken, causing an inability to learn from mistakes and punishment.

  If other people's feelings have zero emotional impact on you, your own goals become the only ones that matter.
  

Edited August 3Aug 3 by Otto Kretschmer

On 8/3/2025 at 1:29 AM, Otto Kretschmer said:

The issue with ASPD folks is that they simply don't feel broken at all. Humans need to feel bad becuase of their actions in order to feel the need for change, ASPD people don't feel that. This is due to two things:

• Their amygdala is severely underactive. This causes a profound lack of fear, sadness, guilt, remorse etc.

• The amygdala-PFC connection is broken, causing an inability to learn from mistakes and punishment.

  If other people's feelings have zero emotional impact on you, your own goals become the only ones that matter.
  

Even if true as written, having a higher than average risk of criminal behavior is not the same as being a criminal.