What about the good people among us? Most humans go about the daily business of life without robbing, raping, or committing murder. Yet, after 40 years of work as both a treating and a forensic psychiatrist, I am absolutely convinced that there is no great gulf between the mental life of the common criminal and that of the everyday, upright citizen. The dark side exists in all of us. There is no “we-they” dichotomy between the good citizens, the “we,” and the criminals, the “they.” Who among us has not had the wish or felt the urge to do something illicit? If we could press a button and eliminate our rivals or enemies with impunity, how many of us would resist? In fact, if this were possible, probably very few people would be left standing. One cannot listen for so many years as patients and criminal defendants reveal their inner lives without coming to the conclusion that bad men and women do what good men and women only dream about doing.
But good men and women are far from perfect in their behavior. We are neither all good nor all bad. To varying degrees, we are a combination of both. An unexpected situation may become the occasion for one side or the other to win out. Combat, for example, may incite the same person to acts of heroism or cowardice, depending on the circumstances. In peace time, a former sadistic concentration camp guard may slip into the role of the respected but feared cop on the beat.
The basic difference between what are socially considered to be bad or good people is not one of kind, but of degree, and of the ability of the bad to translate dark impulses into dark actions. Bad men such as serial sexual killers have intense, compulsive, elaborate sadistic fantasies that few good men have, but we all harbor some measure of that hostility, aggression, and sadism. Anyone can become violent, even murderous, under certain circumstances. Therapists who have undergone their own psychoanalysis or insight psychotherapy have a humanistic recognition of the universality of human intrapsychic experience. These therapists acknowledge in themselves many of the same psychological struggles they find in their patients and in others. It is hoped that therapists handle their personal problems better more of the time, but this is not necessarily so. Dr. Thomas G. Gutheil, Professor of Psychiatry at Harvard and a famed forensic psychiatrist, candidly acknowledges what most therapists know about themselves: “There, but for the grace of better defenses, go I.”
This idea is very difficult for many people to accept. Perhaps our dark side comes from our evolutionary heritage, in which aggression ensured our survival. Maybe it is the result of faulty wiring in our brains. The depletion of certain brain neurotransmitters, such as serotonin, has been found to parallel aggressive behavior. Our brains are wired for aggression and can short-circuit into violence. All of us have aggressive impulses. His Holiness Tenzin Gyatso, the 14th Dalai Lama of Tibet, and the winner of the 1989 Nobel Peace Prize, spoke of the dark side of his dreams to an interviewer:
In my dreams, sometimes women approach me, and I immediately realize, “I’m bhiksbu, I’m monk”—so you see, this is sort of sexual.… Similarly, I have dreams where someone is beating me, and I want to respond. Then I immediately remember, “I am monk and I should not kill.”
It is difficult to underestimate most people’s allegiance to the belief that good men and bad men are fundamentally different or that bad men are “crazy.” Even as you read this book, you may say to yourself, “Not me. I would never do such things.” You may never have considered the acts committed by the persons depicted in these pages, or, if you did consider any of them, you quickly rejected the notion as “sick.” Yet psychiatrists know that if people are removed from their normal world, without their usual external controls and surroundings, they may take liberties that previously they could only have imagined. For example, after a major disaster, there is always looting. Many looters are people who never before considered robbery. Usually, there are so many looters that the authorities must institute martial law to regain control of the situation. Members of a crowd act in ways that they would not consider as individuals. Being part of a crowd does not eliminate an individual’s thinking or control as much as it can nullify the person’s conscience. Who can forget the televised scenes of looting following the Katrina disaster?
People’s antisocial impulses are opportunistic. After major disasters in the United States, fake and inflated damage claims cost the insurance industry tens of billions of dollars. Similarly, thousands upon thousands of ordinary folk regularly cheat on their income taxes or fail to file altogether. Polygraph operators who conduct preemployment examinations of normal persons for industry soon discover that an incredible number of illegal acts, sexual deviations, addictions, and all manner of unimaginable, bizarre activities are admitted to by the examinees. During fraternity initiations or in the hazing of cadets at military academies, extremes of behavior occur. Atrocious acts are routinely reported—some that even result in deaths. These tortures are not acts perpetrated by devilish people but by our privileged, “normal” young men and women—those we consider to be our hope for the future.
I mention these seeming contradictions because I believe that you, the reader, can derive the most benefit from this book if you do not fall prey to the good man–bad man illusion—the belief that good men and women do not have a sinister dark side. Nothing could be further from the truth. It is likely that among the deviant behaviors portrayed within these covers, you will grudgingly recognize aspects of your own human condition. For some, that realization may be personally threatening—it may even make them want to put the book down and go no further with it. I hope that will not happen to you. I hope that the knowledge gathered in this book will cause you to change, to be more accepting of your humanity and that of other people. But if, after reading this book, you still believe that good men and bad men are worlds, maybe even universes apart, will you also continue to curse the darkness and thereby deny your own humanity? Or will you simply lose an opportunity to gain insight into recognizing, harnessing, and productively channeling the dark side we all share? This book presents an opportunity. If I can help you realize that this opportunity must be seized rather than denied, then I will have succeeded in an important task, and it is hoped I will have enriched your life.
Two Perspectives
In a courtroom, I am invariably asked about my bona fides—why I am qualified to give an opinion—and I want to answer the same question here by suggesting that as a forensic psychiatrist and as a treating psychiatrist, I am able to bring two different perspectives to the subject of humanity’s darker side. In my forensic practice, I have often been asked to evaluate men charged with exhibitionism. Most exhibitionists are generally passive men who feel inadequate about themselves, particularly in the way they relate to women. They are outwardly anything but macho, “Rambo” types, though they may still be dangerous and may ultimately progress to more aggressive sexual behaviors. What the exhibitionist attempts to accomplish when he exposes himself to a woman is basically to demonstrate that he is not inadequate. The shock he hopes for in the woman’s surprised or stunned expression is aimed at reversing his own fears and inadequacies. By exposing himself, the exhibitionist attains a fantasized dominant position that reduces his anxiety.
In my consulting practice, I see a steady stream of male patients who are struggling with the same underlying problem as the exhibitionists—feelings of inadequacy—but who manifest these feelings in symptoms of impotence, or premature or retarded ejaculation. The exhibitionist has lived out his fantasies, whereas the patient has grappled with similar demons and has instead developed dysfunctional sexual symptoms and inhibitions. The “good” man has come for treatment, whereas the “bad” man has psychologically assaulted and traumatized women. Why the exhibitionist acts out his problem while the patient only develops symptoms is a clinical and theoretical conundrum that psychiatrists have long pondered. It is a question to which there is no easy answer, only a case-by-case analysis.
Forensic psychiatrists often examine criminal defendants who have committed all manner of antisocial acts, perso
ns that they would not generally see in private practice. We evaluate defendants for competency to stand trial. One of our duties is to assist the judicial system in determining whether a defendant was sane or insane at the time of the crime. Forensic psychiatry is involved at all levels of the criminal process, from assessing a person’s competency to confess to a crime to the extremely controversial matter of evaluating competency to be executed. We make pre-sentence evaluations, offer recommendations for disposition and treatment, and advise judges, parole boards, and other law enforcement agencies.
Forensic psychiatrists are also active on the civil side of the system, consulting with attorneys on malpractice cases, in child custody disputes, in personal injury litigation such as that resulting from auto accidents, and in cases involving worker’s compensation, insurance matters (accidental death versus suicide), wills that are being contested, and myriad other litigation matters at the fascinating intersection of psychiatry and law. On administrative matters, forensic psychiatrists are asked to give testimony at legislative hearings—for instance, prior to the enactment of laws governing the sexual misconduct of professionals and the right of an individual to refuse treatment.
As a treating psychiatrist, I see patients with a wellness rather than a litigation agenda. Patients come to us because they are suffering mentally. They are depressed or anxious; they have feelings of panic and unbidden thoughts and actions, as well as personality problems that interfere with their day-to-day functioning and quality of life. Although some of these patients may, from time to time, put their problems into action, in the main their personal difficulties are contained within themselves, manifested only as unpleasant, painful symptoms and inhibitions that often interfere with their personal relationships. Yet, in my experience as a forensic psychiatrist, their dreams can be thematically similar to those of criminal defendants.
That there is an intimate and reciprocal connection between symptoms and destructive acting-out behavior is brought home again and again to the treating psychiatrist. For example, a patient who has been harmfully acting out personal conflicts comes into treatment and simultaneously stops those behaviors, but in their place starts to experience anxiety and depression. These “new” symptoms and their underlying causes then become the focus of treatment. Sigmund Freud insisted that the object of psychoanalysis was to substitute ordinary human unhappiness for neurotic misery. And that is a sensible objective. After all, psychotherapy does not promise utopia. What it does, really, is encourage patients, through the trusting support of the psychiatrist, to face and conquer their personal dragons and to make sense out of their mental difficulties.
Let us be clear about this: at one time or another, most of us will struggle with our personal demons. No one can run from them for very long. One cannot escape them by sticking one’s head in the sand or by retreating into various addictions, because these actions can be as painful as or more disabling than the original problems. I have treated patients who have sought geographical cures to their problems by moving hither and yon, only to reexperience and repeat their problems in a new venue. Psychiatrists aim to empower their patients by helping them to discover alternative, more adaptive problem-solving techniques. To get away from being stuck in automatic ways of thinking, feeling, and behaving, patients learn mental manual overrides and other new ways of dealing with their problems. In a successful treatment, autonomy and responsibility for one’s own life replace previous helplessness and destructive repetitions.
Mad or Bad?
Society, religion, and the law all take moral positions about right and wrong, about the acts of “bad” men, often labeling such persons and their behavior as evil. Medically trained and wedded to the scientific method, psychiatrists do not ordinarily apply the term evil, even to the aberrant destructive acts they are sometimes called upon to understand and explain. Psychiatrists look at causes and effects in human behavior and try not to make moral judgments. What society labels evil behavior, the psychiatrist seeks to understand within the framework of the psychopathology of mental illness or even of everyday life. Although the law holds that each of us has the free will to choose between right and wrong, psychiatrists generally see the human being as a creature who is affected by powerful internal forces and not always free to make rational decisions.
For many people, Jeffrey Dahmer seems the personification of evil. The details of the 17 serial sexual killings associated with him, as brought out by media reports, shocked and sickened many people around the world. Dismembered body parts were found in his apartment. Decomposed torsos floated in acid-filled vats. A refrigerator contained human heads, a freezer held a heart and male genitals. Dahmer confessed that he had drugged and strangled his victims, had sex with their dead bodies, then dismembered them, smashing the bones into small pieces with a sledgehammer. He boiled the heads to remove the skin so he could paint the skulls white, and made meals of the various body parts. Dahmer commented that a bicep tasted like steak.
Was Dahmer inherently bad, or was he mad? The law allows an exception to the rule that a defendant is responsible for a criminal act if, as a result of mental illness, the defendant did not know what he or she was doing or that the act was wrong, or was not able to control the behavior, even if aware that it was wrong. In Dahmer’s trial, the defense claimed that Dahmer could not stop killing because he was mentally ill. Because of a “sickness he discovered, not chose…he had to do what he did, because he couldn’t stop it.” His own attorney described Dahmer as “a steamrolling killing machine” on the track of madness. The forensic psychiatrists at the trial all found some form and degree of mental disorder in Dahmer—how could anyone display such outrageous, sexually violent behavior and not be abnormal? But they differed on whether Dahmer had been able to control himself.
The Milwaukee jury dismissed both the arguments that Dahmer had been mentally ill and that he lacked the substantial capacity to control his murderous behavior, convicting him of 15 murders. In essence, the jury decided that Dahmer was bad and that whatever the degree of his madness, his vile behavior could not be excused by society. Punishment, not treatment, was the message in the jury’s verdict. The judge sentenced Dahmer to 15 consecutive life sentences, roughly 950 years in jail, with no possibility of parole. Dahmer was murdered in prison.
The “Normality” of Evil
Jeffrey Dahmer indeed seems to be the personification of evil, and thus to provide strong evidence against the thesis of this book, which is that bad people do what good people dream. Yet the sadistic traits seen in such serial killers as Jeffrey Dahmer have their tamer counterparts in patients who will never commit a sexually sadistic crime of any kind, who are respectable persons, good mothers and fathers, successful professionals.
I have treated solid citizens who mentally torture their spouses, children, elderly parents, and themselves but would not dream of raising a finger to physically harm anyone. Sexual sadism, dominance, and submission have long been part of the spectrum of human behavior. Power and aggression can be identified as factors in all sorts of human courting and mating behaviors, whether in primitive cultures or in modern and presumably civilized ones. Such behaviors occur along a continuum that stretches from intense fantasies and private, noncriminal sexual acts between consenting partners to the more publicly deplorable behaviors of rape and the baroque and bizarre sexual fantasies that lead to ritualized serial sexually sadistic murders.
The Dahmers of this world are rare, but sadism and power motives are common to all human beings. Patients who are able to be extremely candid about their fantasies will often reveal a rich variety of sexually sadistic fantasies that underlie dysfunctional symptoms and behaviors. Even those who are not so candid prove capable of channeling their sadistic impulses into other, less personally destructive activities. Have you enjoyed watching a professional football game lately? How about boxing or professional wrestling? Horror movies, extreme TV medical dramas, and the constant drum of violent crimes on the local news
command large audiences.
In this book I try to dispel a basic fallacy—that destruction and violence reside only in the acts of bad men and women and not in the thoughts of good people. We must all struggle with the dark forces. In the Middle Ages, ecclesiastical thinking held that aggression and violence were caused by foreign, evil spirits besetting an individual. In the twenty-first century, those of us who exclusively ascribe aggression and violence to sickness fall prey to the same inherently flawed perception of man as did the clerics of the Middle Ages. Although there is no doubt that some of the dramatic violence described in this book is attributable to psychopathic personalities and psychotic individuals, much of it is not. Most of the violence and mayhem in this world are committed not by the mentally ill but by individuals and entire societies not considered to be sick, at least not by any known measure of mental illness. The answer to why such violence occurs lies beyond the psychopathology of evil. No competent psychiatrist is so arrogant as to think that human motivation and behavior can be fully explained by current medical and psychological theories. Only God knows the human mind and heart.
I shall never forget the forensic examination of a woman who was terribly traumatized by witnessing an execution-style killing. During a robbery of a fast food establishment, she witnessed from a back room the shooting of a coworker who was on her knees begging for her life. The coworker’s murderer was a 13-year-old boy. As she related the horrible scene and her personal horror, I became aware of my own acute discomfort. I clumsily commented that the boy himself must have been victimized in some way. I was brought up short by her quick retort: “You must realize, doctor, that there is real evil in this world.” Unfortunately, human history is replete with the “real evil” of atrocities, wars, mass killings, and genocides. Adolf Hitler and the Nazis exterminated perhaps as many as 10 million people. It is estimated that Joseph Stalin and his henchmen deported and murdered 20 million of their countrymen. In addition, the twentieth century saw the Turkish genocide of Armenians, estimated at 1 million people, and the killing of 2 million Cambodians by the Khmer Rouge. In 1994, more than 500,000 people were slaughtered in the Rwandan genocide. As this book goes to press, hundreds of thousands are being slaughtered in Darfur.
Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior Page 2
