Guest Editorial > The Psychopath Test “by Jon Ronson



The Psychopath Test “by Jon Ronson | Roger Steer

Could this book shed light on the behaviours of some top managers and others in the NHS? Roger Steer looks beneath the superficial charm for some clues

The Psychopath Test “by Jon Ronson



This entertaining book is billed as a journey through the madness industry but it is reviewed for the insights it may have for the NHS, and its management. It is territory covered in an article in the HSJ “Snakes on the make: do you work with a psychopath? 3 August, 2009 by Jenny Rogers.


The psychopath test identifies an individual’s ability to demonstrate the following items on a checklist:

Glibness/Superficial charm; grandiose sense of self worth; need for stimulation proneness to boredom; pathological lying; cunning/manipulation; lack of remorse; shallow affect; callous/ lack of empathy; parasitic lifestyle; poor behavioural control; promiscuous sexual behaviour; lack of realistic long term goals; early behavioural problems; impulsivity; irresponsibility; failure to accept responsibility for own actions; many short term marital relations; juvenile delinquency; revocation of conditional relaese; criminal versatility


Individuals are marked on a scale of 0-40 and scores of over 30 raise concerns.  About 1% of the population display such characteristics but some 4% or more of top managers.


Given events in Mid Staffs and in other hospitals should we be concerned that the NHS may have not only its fair share of psychopaths at the top but perhaps an over representation?


It is a fair point that whatever the individual eccentricities of individuals that proper governance, involving multidisciplinary teams of management, independent non-executive board members, regulators, professional bodies, patient bodies, overview and scrutiny bodies, legal safeguards etc., should be able to manage the aberrant individual. The retort is that dominant, manipulative top managers can defeat such governance arrangements and a management culture can be promoted which exalts strong leadership, ends before means, and the exercise of power rather than the discretion of the powerful.


Such a culture existed within BP to disastrous effect (the phrase used by managers was – what part of 25% (savings) do you not understand?).The consequences there were explosions in oil refineries and in the Gulf costing many lives and billions of dollars.


Could it be that the mantra of £20bn savings , the promotion of targets before care, the determination to drive reconfigurations through despite the lack of support, clinical evidence or clear financial advantages, and the unwillingness to listen to others is a sign of psychopaths at the top?


The answer according to this book is that we should be cautious in applying the label but that reforming a true psychopath is a fool’s errand. Psychopaths need to be rooted out. The residual question is whether the corporate culture of the NHS has become affected?


Roger Steer


“The Psychopath Test “by Jon Ronson: Picador London 2012 £8.99 (paperback)