That's really an interesting question. What about the ones who really ARE insane psychopaths? Do they think they are doing the right thing, or do they really just not care?

I'm inclined toward the latter, actually. I've read some of Stalin's journals, where he says things like "What is efficient is good. What is inefficient is bad." That sounds like he literally doesn't understand what morality MEANS to ordinary, non-psychopathic people.