This chapter begins with a brief history of the concept of psychopathy, before moving on to outline recent thinking around whether psychopathy is both inherited and acquired. The biological and psychological impact of early experiences is examined, upon how – and whether – the human capacity for guilt fully evolves or remains stunted. Three case vignettes illustrate the psychopathic superego in action, and the place of punishment in the form of criminal sanctions questioned. The chapter concludes with some observations about the considerable risks and possible benefits of treatment.