Curious about what subsequently happened to this man, I recently tracked down his prison files. I learned that he had received parole a year after I had left the prison, and that he had been killed during a high-speed police chase following a bungled bank robbery. The prison psychiatrist had diagnosed this man as a psychopath and had recommended against parole. The parole board could not really be faulted for having ignored this professional advice. At the time, the procedures for the diagnosis of psychopathy were vague and unreliable, and the implications of such a diagnosis for the prediction of behavior were not yet known. As we will see, the situation is quite different now, and any parole board whose decision does not take into account current knowledge about psychopathy and recidivism runs the risk of making a potentially disastrous mistake.
ELSA AND DAN
She met him in a laundromat in London, where she was taking a year off from teaching after a stormy and exhausting divorce. She’d seen him around the neighborhood, and when they finally started to talk she felt as if she knew him. He was open and friendly and they hit it off right away. From the start she thought he was hilarious.
She’d been lonely. The weather was grim and sleety, she’d already seen every movie and play in the city, and she didn’t know a soul east of the Atlantic.
“Ah, traveler’s loneliness,” Dan crooned sympathetically over dinner. “It’s the worst.”
After dessert he was embarrassed to discover he’d come out without his wallet. Elsa was more than happy to pay for dinner, more than happy to sit through the double feature she had seen earlier in the week. At the pub, over drinks, he told her he was a translator for the United Nations. He traveled the globe. He was, at the moment, between assignments.
They saw each other four times that week, five the week after. Dan lived in a flat at the top of a house somewhere in Hampstead, he told her, but it wasn’t long before he had all but moved in with Elsa. To her amazement, she loved the arrangement. It was against her nature, she wasn’t even sure how it had happened, but after her long stint of loneliness she was having the time of her life.
Still, there were details, unexplained, undiscussed, that she shoved out of her mind. He never invited her to his home; she never met his friends. One night he brought over a carton filled with tape recorders—plastic-wrapped straight from the factory, unopened; a few days later they were gone. Once Elsa came home to find three televisions stacked in the corner. “Storing them for a friend,” was all he told her. When she pressed for more, he merely shrugged.
The first time Dan failed to show up at a prearranged place, she was frantic that he’d been hurt in traffic—he was always darting across the street in the middle of the block.
He stayed away for three days and was asleep on the bed when she came home in midmorning. The odor of rancid perfume and stale beer nearly made her sick, and her fear for his life was replaced with something new for her: awful, wild, uncontrollable jealousy. “Where have you been?” she cried. “I’ve been so worried. Where were you?”
He looked sour as he woke up. “Don’t ever ask me that,” he snapped. “I won’t have it.”
“What—?”
“Where I go, what I do, who I do it with—it doesn’t concern you, Elsa. Don’t ask.”
He was like a different person. But then he seemed to pull himself together, shook the sleep off, and reached out to her. “I know it hurts you,” he said in his old gentle way, “but think of jealousy as a flu, and wait to get over it. And you will, baby, you will.” Like a mother cat licking her kitten, he groomed her back into trusting him. And yet she thought what he’d said about jealousy was so odd. It made her sure that he had never felt anything like the pain of a broken trust.
One night she asked him lightly if he felt like stepping out to the corner and bringing her an ice cream. He didn’t reply, and when she glanced up she found him glaring at her furiously. “Always got everything you wanted, didn’t you,” he said in a strange, snide way. “Any little thing little Elsa wanted, somebody always jumped up and ran out and bought it for her, didn’t they?”
“Are you kidding? I’m not like that. What are you talking about?”
He got up from the chair and walked out. She never saw him again.
THE TWINS
On their twin daughters’ thirtieth birthday, Helen and Steve looked back with mixed feelings. Every burst of pride in Ariel’s accomplishments was cut short by an awful memory of Alice’s unpredictable, usually destructive, and often expensive behavior. They were fraternal twins but had always borne a striking physical resemblance to each other; however, in personality they differed like day and night—perhaps the more appropriate metaphor was heaven and hell.
If anything, the contrast had grown starker over three decades. Ariel had called last week to share great news—the senior partners had made it clear to her that if she continued as she was, she surely would be invited to join their ranks in four or five years. The call from Alice—or rather Alice’s floor counselor—was not so cheerful. Alice and another resident at the halfway house had left in the middle of the night and hadn’t been seen in two days. The last time this had happened, Alice had surfaced in Alaska, hungry and penniless. By then, her parents had lost count of how many times they had wired money and arranged for Alice to fly home.
While Ariel had had her share of problems growing up, they had always been more or less normal. She had been moody and sullen when she didn’t get her way, even more so during adolescence. She had tried cigarettes and marijuana in her junior year in high school; she had dropped out of college in her sophomore year, fearing that her lack of direction meant that she lacked potential. During that year in the work force, though, Ariel decided on law school, and from that point on nothing could stop her. She was focused, fascinated, and ambitious. She made Law Review in school, graduated with honors, and landed the job she went after in her first interview.
With Alice, there had always been “something a little off.” Both girls were little beauties, but Helen was amazed to see that even at age three or four Alice knew how to use her looks and her little-girl cuteness to get her way. Helen even felt that somehow Alice knew how to flirt—she put on all her airs when there were men around—even though having such thoughts about her young daughter made her feel terribly guilty. Helen felt even guiltier when a small kitten given to the girls by a cousin was found dead, strangled, in the yard. Ariel clearly was heartbroken; Alice’s tears seemed a little forced. Much as she tried to banish the thought, Helen felt that Alice had had something to do with the kitten’s death.
Sisters fight, but again, “something was off,” in the way these twins went at it. Ariel was always on the defensive; Alice was always the aggressor, and she seemed to take special pleasure in ruining her sister’s things. It was a great relief to everybody when Alice left home at age seventeen—at least Ariel could now live in peace. It soon became clear, however, that upon moving out of the house Alice had discovered drugs. Now she was not only unpredictable, impulsive, and liable to throw fierce tantrums to get her way—she had become an addict, and she supported her habit any way she could, including theft and prostitution. Bail and treatment programs—$10,000 for three weeks at one pricey clinic in New Hampshire—became a continual financial drain for Helen and Steve. “I’m glad somebody in this family is going to be solvent,” Steve said when he heard Ariel’s good news. He had been wondering for some time just how much longer he could afford to clean up after Alice. In fact, he had seriously been reconsidering the wisdom of trying to keep her out of prison. After all, wasn’t it she, not he and Helen, who should face the consequences of her actions?
Helen was adamant on the subject: No child of hers would spend a single night in prison (Alice had already spent quite a number of them, but Helen chose to forget) as long as she was there to pay bail. It became a question of responsibility: Helen fully believed that she and Steve had done something wrong in bringing up Alice, although in thirty years of intense self-scr
utiny she honestly couldn’t identify their mistake. Perhaps it was subconscious, though—maybe she hadn’t been as enthusiastic as she might have been when the doctor told her he suspected she would have twins. Maybe she had unknowingly slighted Alice, who was heartier than Ariel at birth. Maybe somehow she and Steve had set off the Jekyll and Hyde syndrome by insisting that the girls never dress as twins and go to separate dance schools and summer camps.
Maybe... but Helen doubted it. Didn’t all parents make mistakes? Didn’t all parents inadvertently favor one child over the other, if only temporarily? Didn’t all parents feel their delight in their children ebb and flow with the contingencies of life? Yes indeed—but not all parents wound up with an Alice. In her search for answers during the girls’ childhood, Helen had observed other families intensely, and she had seen some very careless, very unfair parents blessed with stable, well-adjusted children. She knew that blatantly abusive parents generally produced troubled if not disturbed children, but Helen was sure that for all their mistakes, she and Steve hardly fell into that category.
So, the girls’ thirtieth birthday brought Helen and Steve mixed feelings—gratitude that their twins were physically healthy, happiness that Ariel had found security and fulfillment in her work, and the old, familiar anxiety as to Alice’s whereabouts and welfare. But perhaps the overriding feeling as this long-married couple drank a toast to their absent daughters’ birthday was dismay that after all this time nothing had changed. This was the twentieth century—they were supposed to know how to fix things. There were pills you could take to recover from depression, treatments to control phobias, but not one of the myriad doctors, psychiatrists, psychologists, treatment counselors, and social workers who had seen Alice over the years had come up with an explanation or an antidote for her problem. Nobody was even sure whether she was mentally ill. After thirty years, Helen and Steve looked across the table and asked sadly, “Is she crazy? Or just plain bad?”
Chapter 2
Focusing
the Picture
He will choose you, disarm you with his words, and control you with this presence. He will delight you with his wit and his plans. He will show you a good time, but you will always get the bill. He will smile and deceive you, and he will scare you with his eyes. And when he is through with you, and he will be through with you, he will desert you and take with him your innocence and your pride. You will be left much sadder but not a lot wiser, and for a long time you will wonder what happened and what you did wrong. And if another of his kind comes knocking at your door, will you open it?
—From an essay signed, “A psychopath in prison.”
The question remains: “Is Alice mad or bad?”
It’s a question that has long troubled not just psychologists and psychiatrists but philosophers and theologians. Formally stated, is the psychopath mentally ill or simply a rule breaker who is perfectly aware of what he or she is doing?
This question is not just a semantic one; posed another way, it has immeasurable practical significance: Does the treatment or control of the psychopath rightly fall to mental health professionals or to the correctional system? Everywhere in the world, judges, social workers, lawyers, schoolteachers, mental health workers, doctors, correctional staff, and members of the general public need—whether they know it or not—the answer.
THE RAMIFICATIONS
OF THE QUESTION
For most people, the confusion and uncertainty surrounding this subject begin with the word psychopathy itself. Literally it means “mental illness” (from psyche, “mind”; and pathos, “disease”), and this is the meaning of the term still found in some dictionaries. The confusion is compounded by the media use of the term as the equivalent of “insane” or “crazy”: “The police say a ‘psycho’ is on the loose,” or, “The guy who killed her must be a ‘psycho.’ ”
Most clinicians and researchers don’t use the term in this way; they know that psychopathy cannot be understood in terms of traditional views of mental illness. Psychopaths are not disoriented or out of touch with reality, nor do they experience the delusions, hallucinations, or intense subjective distress that characterize most other mental disorders. Unlike psychotic individuals, psychopaths are rational and aware of what they are doing and why. Their behavior is the result of choice, freely exercised.
So, if a person with a diagnosis of schizophrenia breaks society’s rules—say, by killing the next passerby in response to orders “received from Martian in a spaceship”—we deem that person not responsible “by reason of insanity.” When a person diagnosed as a psychopath breaks the same rules, he or she is judged sane and is sent to prison.
Still, a common response to reports of brutal crimes, particularly serial torture and killing, is: “Anyone would have to be crazy to do that.” Perhaps so, but not always in the legal or the psychiatric sense of the term.
As I mentioned earlier, some serial killers are insane. For example, consider Edward Gein,1 whose horrific and bizarre crimes became the basis for characters in a number of movies and books, including Psycho, The Texas Chainsaw Massacre, and The Silence of the Lambs. Gein killed, mutilated, and sometimes ate his victims, and he made grotesque objects—lampshades, clothes, masks—from their body parts and skin. At his trial both prosecution and defense psychiatrists agreed that he was psychotic; the diagnosis was chronic schizophrenia, and the judge committed him to a hospital for the criminally insane.
Most serial killers are not like Gein, however. They may torture, kill, and mutilate their victims—appalling behavior that sorely tests our ideas of what “sanity” means—but in most cases there is no evidence that they are deranged, mentally confused, or psychotic. Many of these killers—Ted Bundy, John Wayne Gacy, Henry Lee Lucas, to name but a few—have been diagnosed as psychopaths, which means they were sane by current psychiatric and legal standards. They were sent to prison and, in some cases, executed. But the distinction between mentally ill killers and sane but psychopathic murderers was by no means easy to come by. It resulted from a centuries-long scientific debate that at times bordered on the metaphysical.
SOME TERMINOLOGY
Many researchers, clinicians, and writers use the terms psychopath and sociopath interchangeably. For example, in his book The Silence of the Lambs, Thomas Harris described Hannibal Lecter as a “pure sociopath,” whereas the writer of the movie version called him a “pure psychopath.”
Sometimes the term sociopathy is used because it is less likely than is psychopathy to be confused with psychoticism or insanity. In his book The Blooding, Joseph Wambaugh says of Colin Pitchfork, an English rapist-murderer, “... it was a pity that the psychiatrist didn’t choose to describe him as a ‘sociopath’ instead of a ‘psychopath’ in his report, because of the misunderstanding that accompanies the latter. Everyone connected with the case seemed to confuse the word [psychopath] with ‘psychotic’ ”
In many cases the choice of term reflects the user’s views on the origins and determinants of the clinical syndrome or disorder described in this book. Thus, some clinicians and researchers—as well as most sociologists and criminologists—who believe that the syndrome is forged entirely by social forces and early experiences prefer the term sociopath, whereas those—including this writer—who feel that psychological, biological, and genetic factors also contribute to development of the syndrome generally use the term psychopath. The same individual therefore could be diagnosed as a sociopath by one expert and as a psychopath by another.
Consider the following exchange between an offender (O) and one of my graduate students (S):
S: “Did you get any feedback from the prison psychiatrist who assessed you?”
O: “She told me I was a not a sociopath a psychopath. This was comical. She said not to worry about it because you can have a doctor or lawyer who is a psychopath. I said, ‘Yeah, I understand that. If you were sitting on a plane that was hijacked would you rather be sitting next to me or some sociopath or neurotic who shits his p
ants and gets us all killed?’ She just about fell off her chair. If someone wants to diagnose me I’d rather be a psychopath than a sociopath.’ ”
S: “Aren’t they the same thing?”
O: “No, they’re not. You see, a sociopath misbehaves because he’s been brought up wrong. Maybe he’s got a beef with society. I’ve got no beef with society. I’m not harboring hostility. It’s just the way I am. Yeah, I guess I’d be a psychopath.”
A term that was supposed to have much the same meaning as “psychopath” or “sociopath” is antisocial personality disorder, described in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III; 1980) and its revision (DSM-III-R; 1987), widely used as the “diagnostic bible” for mental illness.2 The diagnostic criteria for antisocial personality disorder consist primarily of a long list of antisocial and criminal behaviors. When the list first appeared it was felt that the average clinician could not reliably assess personality traits such as empathy, egocentricity, guilt, and so forth. Diagnosis therefore was based on what clinicians presumably could assess without difficulty, namely objective, socially deviant behaviors.
The result has been confusion during the past decade, with many clinicians mistakenly assuming that antisocial personality disorder and psychopathy are synonymous terms. As diagnosed by the DSM-III and the DSM-III-R, as well as by the recently published DSM-IV (1994), “antisocial personality disorder” refers primarily to a cluster of criminal and antisocial behaviors. The majority of criminals easily meet the criteria for such a diagnosis. “Psychopathy,” on the other hand, is defined by a cluster of both personality traits and socially deviant behaviors. Most criminals are not psychopaths, and many of the individuals who manage to operate on the shady side of the law and remain out of prison are psychopaths. Keep this in mind if you have occasion to consult a clinician or counselor about a psychopath in your life. Make sure that he or she knows the difference between antisocial personality disorder and psychopathy.3
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