The Psychopath Inside: Summary & Review

the psychopath inside book cover

The Psychopath Inside (2013) is the autobiographical account of James Fallon, a neuroscientist who found out he had the brain wiring of a psychopath.
The book takes the readers on a dual journey: a scientific one, with plenty of details on neuroscience, and a personal one, with Fallon’s own life as a high-functioning psychopath. 

Key Takeaways

  • Psychopathy is inborn, but to become a “full-blown, anti-social psychopath” you also need a bad childhood and a warrior gene
  • There is no precise definition for a psychopath, and no exact science to measure psychopathy
  • Mild traits of psychopathy can be advantageous for the individual, as well as for society (but full-blown psychopathy, above 30, is not)


About The Author: James Fallon is an American neuroscientist. He is professor of psychiatry and human behavior and professor of anatomy and neurobiology at the University of California, Irvine School of Medicine.

There Is No Precise Definition of A Psychopath

Searching for a definition of a psychopath, Fallon had to agree that there wasn’t any.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) only lists “antisocial personality disorder”, but it’s not the same.
As Dr. Rober Hare also explains, most criminals are antisocial, but not all criminals and antisocial personalities are psychopaths.

Says Fallon:

Many doctors and researchers have their own definitions of what makes a psychopath. The problem is, every definition is different and none are cut-and-dried.

We Still Know Too Little of The Brain to Be Accurate (But We Can Still Spot a Psychopath)

One of the reasons there are no precise definitions and no accurate criteria to measure psychopathy is that we still know little of the brain.

Says Fallon:

Diseases are based on knowledge of the cause (or etiology) of a particular disorder and the effects (or pathophysiology) they have on the body. Unlike for many true diseases of other organ systems, we don’t have this luxury with diseases of the mind since so little is known of the underlying pathological biological mechanisms at work.

And more on psychopathy as a “disorder” of the brain:

Therefore, most psychiatric problems are called disorders or syndromes. Psychopathy stands on the lowest rung of this disease-disorder ladder, since no one agrees on what defines it—or if it exists at all—and so there is no professional agreement as to the underlying causes.

And he takes a swing at the “Hare Checklist”:

Trying to identify or define psychopathy with just a checklist of traits and no cause is like using a field taxonomy guide. If it flies and eats and makes noises it could be a bird, but it could also be a bat or an insect; you haven’t nailed down what the thing really is.

However, on top of the widely used and recognized PCL-R (Psychopathy Check List Revised), there are a number of scientific tests we can run, including:

  • PET (positron emission tomography)
  • fMRI (functional magnetic resonance imaging)
  • Genetics tests
  • Behavioral and psychometric tests

Taken together, these tests can reveal symptoms that can point towards a psychiatric disorder.
Plus, ends Fallon:

I see psychopathy like others see art; I can’t define it, but I know it when I see it.

Lack of Empathy: The Defining Trait

Most psychiatrists agree that one of the defining characteristics of psychopaths is the lack of interpersonal empathy.

Psychopaths live in what may be defined as a “flat emotional playing field”.

Cold & Hot Cognition

  • Cold cognition is rationality independent of emotions: emotionless processing of thoughts, perceptions, short-term or executive memories, plans, and rule-making
  • Hot cognition is emotional cognition through and with emotions: Fallon includes in this category emotional memory and socially, ethically, and morally programmed behaviors.

Connecting with others requires both cold cognition, where you understand what they’re thinking and what’s an appropriate response, and hot (emotional) cognition, where you can empathize with their feelings and attitudes.

Someone with damage to the hot system might have difficulties predicting other people’s thoughts and, most of all, sharing his feelings. 

Theory of Mind

Fallon defines theory of mind as:

elaborated medial prefrontal system that allows us to consider others’ thoughts and beliefs, even if they’re different from our own

The author says there might be a dichotomy between empathy and theories of mind.

My Note: Did he mean “link between empathy and theories of mind”?
I didn’t get the point and it feels like Fallon used the wrong word there.

Autistic people have empathy but no theory of mind, while psychopaths have theories of mind but lack empathy.

That means that psychopaths lack emotional empathy, but have cognitive empathy. 
Such as, they can guess what you are feeling, but do so without in a cold and calculated way, without feeling sympathy.

Says Fallon (bold and italic are mine):

A psychopath has a poorly functioning ventral system, usually used for hot cognition, but he can have a normal or even supernormal dorsal system, so that without the bother of conscience and empathy, the cold planning and execution of predatory behaviors becomes finely tuned, convincing, highly manipulative, and formidable.
Because psychopaths’ dorsal systems work so well, they can learn how to appear that they care, thus making them even more dangerous.

Also read:

Manipulation: Techniques, Strategies, & Ethics

Brain Damage Is Necessary For Psychopathy, But A Bad Environment Is Needed, Too

The author was a staunch believer that we are shaped by nature, not nurture.

But as he got to know himself more, and as he began to research, he started changing his mind.

My note: some of his evidence for nurture VS nature is lacking
Read the criticism for more

Genes and environment interact in a number of ways:

  • Genotype-environment correlation: if your father is aggressive, he will pass on the genes, but also the attitude at home which will reinforce those genes. And an aggressive attitude in life might lead to more confrontations, making the kid even more aggressive
  • Epigenetic marking: a “tag” of chemical information that only gets activated under certain situations and with certain environment-related stimuli.
    Says Fallon: “the genome is the book you inherited at birth, the epigenome is the way you read that book”

But Don’t Exaggerate the Role of Nurture

Fallon also makes a note that we shouldn’t overplay the importance of nurture.
He says:

Kids are malleable, but mostly at the extremes. In the absence of bad abuse or extreme genetics, kids will turn out okay.

A New Theory of (Criminal) Psychopathy

Fallon comes up with his own new theory on psychopathy, which requires 3 legs:

  1. Unusually low functioning of the orbital prefrontal cortex and anterior temporal lobe, including the amygdala
  2. The high-risk variants of several genes, the most famous being the warrior gene
  3. Early childhood emotional, physical, or sexual abuse.

He calls it “theory of psychopathy”, but he seems to be referring to the more extreme version of psychopathy, the more criminal and violent one.

Psychopaths Cannot Change Themselves

One of the chapters is called “can you change a psychopath?”.

Fallon’s answer is:

We are machines and cannot fundamentally change ourselves through sheer force of will.

But Fallon also acknowledges that a little change might happen if he changes the narrative of his actions and motives (ie.: reframing).
He says:

I could be like someone who describes himself as having a refreshing, flexible, open, and healthy attitude to sex, rather than just admitting to himelf that what he really is is promiscuous.

But then again, he adds, that wouldn’t change the nature of the underlying behavior.

He could try to push through a plan of behavioral redemption, but the problem with that is that he doesn’t care to change.

He could control a specific issue of his behavior, but if he did so, all his energies would be sucked up in that one thing.
It’s like Oprah controlling her weight. Oprah is not lacking willpower, and if all she did was focusing on her weight, she could stay thin. But if she wants to also pursue all her other ambitions, she will get back to putting on weight.

For other possible cures and drugs, says Fallon:

Psychopathic tendencies are particularly hard to fight, and attempted cures may make only small differences.
Drugs that influence the monoamine neurotransmitter systems can partially reduce impulsivity and aggression, and early interventions involving diet and meditation can decrease behavioral problems, but the core neuropsychological deficits leading to lack of empathy and remorse remain.
There are no magic bullets.

Psychopathy Might Rise in Areas With Chronic Violence

If psychopathy is partially nurture and environment, then it convenes that bad nurturing and bad environment will churn more psychopaths.

Indeed, says James Fallon:

I’ve hypothesized that in areas with chronic violence, from Gaza to East L.A., the concentration of genes associated with psychopathy might be increasing as women mate with bad boys for protection and aggressive genes spread, increasing the violence and repeating the loop. Over generations, we end up with warrior societies. It’s a speculative idea but one that’s important to consider and study further.

However, I would add, the opposite is also true.
And in peaceful areas, women might be happier with kinder and more protective men, and the genes for kindness and pro-sociality might increase.

I have personally noticed that in safer and more peaceful countries and cities, women are afraid of too direct approaches. 
Instead, they respond much better to “social circle game”, or to more careful approaches where the man can put them at ease.

The Usefulness of Psychopaths

In the last chapter, Fallon discusses two important topics:

  • Why psychopaths exist at all
  • The “utility” of psychopaths to society

He says that, since psychopaths exist and are still among us since the dawn of time, then it means that at individual level psychopathy must be somewhat useful.
At least at moderate levels, he adds, making a note that full-blown psychopathy might not be useful, but just a question of randomness:

Perhaps full psychopaths, those scoring 30 points or more on the Hare Checklist, are just a statistical fluke or a roll of the dice in the genetic casino, amassing too many of the genes that are helpful individually.
But 2 percent is a lot of people. And that number is constant across races, even though the prevalence of specific genes, such as the warrior gene, vary widely. We should consider why psychopathic traits might be individually advantageous, or at least tolerable, from an evolutionary standpoint.

Among the advantages of psychopathy Fallon lists:

  • Ability to lie without giving out “tells” (my note: this is useless though since people are NOT good at catching other people’s lies)
  • Less anxiety, which means a better functioning immune system (my note: not that useful when psychopaths, with poorer impulse control, indulge in heavy drinking and drug abuse)
  • Manipulation of mates: known psychopaths have women waiting for them outside prisons, while unknown psychopaths are still good with women thanks to their ability to fake unconditional love (my note: only partially true, see “the myth of the psychopath seducer“)

However, it’s true that psychopaths can be very good at manipulating and controlling mates.

Psychopaths’ Sexual Strategy: Marauders of Sex

The Benefits of Psychopathy to Civilization

At a group level, psychopaths can make for strong leaders.

They tend to take more risks, which may or may not work in favor of the group. But more risks can benefit civilization as a whole.

Says Fallon:

On a larger scale, it benefits civilization to have groups take chances, because some will succeed and move civilization forward—just as biological evolution benefits from mutations, even though many of them are deadly.

He may have a point there.

And he keeps on going:

I don’t think we should remove the psychopathy-related traits and genes from society. It would lead to passivity and wipe us out. (…) Individuals with low empathy and high aggression, if they’re treated well, can have a positive impact.
Of course, they put stress on their families and friends, as I do, but on a macro level they’re beneficial to society.

I don’t believe the “wipe us out”, that’s exaggerated BS.
But he might have a point here:

I believe there’s a sweet spot on the psychopathy spectrum.
People who are twenty-five or thirty on the Hare scale are dangerous, but we need a lot of twenties around—people with the chutzpah and brio and outrageousness to keep humanity vibrant and adaptable—and alive.

Also read:

Psychopathy Exists In Business Because People Want Quick Returns

Fallon quotes Hare to say that psychopathy is common in high-returns professions such as investment banking (Hare, 2006).

Fallon says that psychopathy is popular in business because people expect quick returns on their investment.
I quote him:

The general public wants to make that quick and easy buck and, while lacking their own combination of high risk and knowledge, use hired guns like Madoff and other investment mavens to do their dirty work for them.

Sure, it may turn out the psychopath was in it only for himself, acknowledges Fallon, but common experience still shows that we fall for the strong risk-taker.

The author mentions Kent Kiehl, a psychopath researcher, who estimated the social costs of psychopathy at $460 billion a year, in 2011 dollars.
But Fallon disagrees, saying that psychopaths might also save money. For example, by being less emotional and more surgical in their operations.

Also read:

Psychopaths in Armies Are A Double-Edged Sword

Fallon says that psychopaths make for good warriors.

But that comes at a high cost, as Fallon himself admits:

The problem with inviting psychopaths to war, however, is that the military also wants soldiers to be team players who can connect with their unit and fight not only against the enemy but for their own.

Turning Normal People Into Psychopaths

Fallon talks about a former colonel who said he was able to switch his fighting instinct on and off, at will.

He could go on a killing mission and then be a loving man once the mission was over.

So he wonders: could it be possible to do the same for everyone?
Says Fallon:

Can such an effective emotionality on-off switch be (…) applied to the recruitment and training of combat personnel? This can be determined, but probably at a cost of hundreds of millions of dollars in long-term research.
One option is to artificially flip the switch using transcranial magnetic stimulation (TMS). If you put a focused electromagnetic coil in the helmet you might be able to disrupt emotionality at the flip of a literal switch. Off: social mode. On: killer mode.


On colleagues calling him a “psychopath”:

People often refer to others as “crazy” or “a psychopath” without meaning it literally. Looking back, though, I probably should have paused to consider the sources in my case: trained psychiatrists who specialized in mood and brain disorders and would probably not be so quick to abuse a professional term simply because they were mad.

On effective manipulation;

You don’t manipulate people by snarling. You do it by being sweet as shit.

On “proper” psychopathy:

I don’t want to kill anybody or hurt anybody. And I don’t like to steal things or lie. That’s for losers. If you have to do that, you’re a disappointment as a psychopath. Violence is crude and it destroys the fun. My concern is not moral but practical: I’m looking to get the most bang.

On the power of good nurturing:

Real nurture can overcome a lousy deck of cards dealt at birth by nature. There are good behavioral, genetic, epigenetic, psychiatric, and social reasons to clean up neighborhoods and to treat vulnerable children with an extra bit of love. 

More Wisdom

  • The earlier the abuse, the more harmful it is: “the later the stressors, like emotional or physical abuse, occur, the less the effect will tend to be”
  • The The “Macdonald triad” is not really predictive of psychopathy: bedwetting is not a great predictor, and animal cruelty and fire-starting are relatively common among boys
  • You can have sympathy without empathy: You can have sympathy without empathy, says Fallon. Sympathy is the ability to retrieve emotional memories, including memories that can predict what type of pain is about to befall others, together with the will to help that person
  • Libertarians are fairness above emotions: libertarians rely more on a sense of fairness and justice than on how they feel emotionally about a person or a group of people. Gandhi and Mother Theresa might be two examples that fought for grander causes, but cared little about individuals


Take it with a pinch of salt: there are some typical overblown psychopath stories (lies)

Psychopaths, same as chronic liars, tend to make up grandiose, exaggerated stories that sound either out of a movie, or plain impossible.

See for yourself if this sounds realistic:

I jumped out of my car and ran down the hill and was just able to crawl through a smashed window to position myself over the face of the driver, who was an elderly gentleman in the throes of death.
His chest was crushed and while he was vomiting and regurgitating blood into my face, I kept him revived by mouth-to-mouth for about twenty minutes, until the police arrived. They pulled me out of the man’s car by my legs, and I was furious, since I was so intent on reviving him. After testifying at the police station, I ended the interview melodramatically by throwing the old man’s bloodied dentures onto the police sergeant’s desk.

Yeah, and then the hero music started playing for James.

If we believe it’s possible that story is not really (fully) true, how much of the rest can we take for good?

Overplaying the role of nurture?

Says Fallon:

A small survey of thirty-five psychopathic offenders in youth detention facilities found that 70 percent reported serious mistreatment throughout childhood.
Given that the onset of reliable memory for childhood events in adults may reach back to three to four years of age (…) it was possible that more than 90 percent of them were abused (…). Add to this those psychopaths who protect their abusers, and the percentage could approach 99 percent, or so I reasoned.

Well, that’s quite some mental legwork to go from 70% to 99%. On such a small survey, too.

And again:

I looked at all the case studies I could find in the literature and in my work, and saw that for all the psychopaths, including dictators, who had psychiatric reports from their youth, all had been abused and often had lost one or more of their biological parents.
While there may be cases where this is not true, I could not find any proven ones. There were cases where the murderer denied early abuse, but many people will deny such abuse, only for it to be discovered later that either they were too embarrassed to admit it, or they were protecting the abusing adult, typically a family member.

So, wait a second, the author is taking criminals who said they were abused at their words, but does not accept criminals who said they were not abused?

It makes no sense.
There also incentives in making up abusive stories to gain sympathy with the jury.

Indigo child woo-woo

The author says he always thought of Indigo and Orchid children as woo-woo pseudo-science.
But then he says, when he started reading the description, it made sense, because it described him well.

Is Fallon not aware that, given any positive description, people will naturally recognize themselves in them? 
That’s how horoscopes keep being perpetrated… 


  • Somewhat confusing terminology 

The book is somewhat confusing with the terminology.

Fallon calls himself a psychopath, but when he refers to other psychopaths, he seems to mostly talk about criminal and violent psychopaths.

Also the terminology around empathy/sympathy required me to do some double checking.

  • High-functioning psychopathy is not a new thing

The author says that brain damage is a precondition for psychopathy, but bad parenting and a poor childhood is also necessary.

However, what he is describing is a variant of psychopathy, the more violent one.
It’s long been known in the literature that not all psychopaths are violent, and that other factors behind genes are involved (Stout, 2005).

  • “Me, me, me” attitude

Sure, the book is an autobiography, but sometimes it feels like the author is a bit too intent on blowing his own horn.

  • Some contradictions

This goes back to “how much can you trust the author”.

The author says he’s a terrible flirt, and that his wife Diane knows it because she knows how women respond to him.

But just the line before that, he says that if a girl tells him “Do you wanna do it now?” that’s good enough for him because he feels he’s been validated and he could control those women.

Well, those two statements are somewhat in contradiction. 
And so are his stories around women: sometimes he said he never cheated, some other times he makes it sound like he is chasing women or enjoying their company. 


  • Great text for neuroscientists

Fallon knows his stuff, and while he might lose some non-scientists with his long brain description, those will certainly be helpful and appreciated by fellow scientists and researchers.

  • Very good to understand psychopathy

Texts about psychopaths written by psychopaths will always provide readers with a new angle with which to understand psychopathy.

Sure, sometimes you have to read between the lines, because psychopaths like and self-aggrandize, so you need to be able to weed through the chaff, but that’s also part of the experience of learning about psychopathy.

It makes a good companion with “Confessions of A Sociopath“.

  • A smart author, and a scientist with critical thinking skills

There were just a few instances in which Fallon seemed to “massage” the numbers, or to accept some woo-woo, both of which are highlighted above.

However, overall, this is a smart guy with high critical thinking skills. And he’s mostly a neutral writer who writes based on facts.


“The Psychopath Inside” is an entertaining and instructive read.

It deepened my understanding of psychopathy and dark-triad traits, and also slightly shift my personal position when it comes to psychopathy.

I got to Fallon after reading the work of Dutton, and my take on psychopathy has shifted after Dutton and Fallon.

Before these two I had read a few papers and books from Martha Stout, Kent Kiehl, and (several from) Robert Hare.
Stout and Hare tend to portray psychopathy in the typical sense of “high danger, stay away” and “no contribution to society, only taking”. And it’s not like I disagree with it.
However, it’s not the full story.
Robert Hare, albeit considered one of the leading world experts on psychopathy, is not enough to truly understand psychopathy -as I mentioned in the criticism on Hare’s book, he mostly analyzed criminal psychopaths-.

James Fallon adds another piece to the puzzle.
Somewhat, he makes psychopathy more about shades of grey. And a mixture of nature and nurturing, and not mostly nature as it was previously thought.

Furthermore, Fallon is only one of the first and few authors making the case that some mild traits of psychopathy can be helpful for personal success, as well as being potentially -potentially and in some cases!- beneficial for society.
Albeit it’s an understandably controversial stance, I tend to agree with it and believe that the “shades of grey” approach to psychopathy is more realistic and helpful -and that is without abandoning the more extreme approach, valid especially with more extreme psychopaths, that you better stay away and that many of them are best in prison-.

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