by Gwen Adshead
In 1941, an American psychiatrist, Hervey Cleckley, published a landmark study called The Mask of Sanity,4 which brought the idea of the ‘psychopath’ into popular usage. It is ironic to think that Cleckley was working on his book at the same time as the Nazi government in Germany was developing its Final Solution – the mass slaughter of Jewish citizens – which was finalised at the Wannsee Conference in January 1942, soon after The Mask of Sanity was published. I’ve always wondered what Cleckley would have made of that gathering, had he known anything about it. Would he have described them all as psychopaths?
Cleckley studied a group of people who appeared ‘normal’ and might even have had a certain charm, but who showed no concern about other people’s feelings. Many of the subjects had been referred by their parents or partners, who complained about their repeated lies, manipulative nature, and emotional shallowness and insincerity, as well as their apparent disregard for social mores or rules. Crucially, these men and women did not seem to experience remorse or care about the distress they caused their families; they would promise to change their ways, but they never did. It is important to note that few of Cleckley’s psychopaths were seriously violent or cruel; some may have served brief sentences for fighting or theft, but not for severe violence. It is also striking that the three women he chose to include as examples of female psychopaths appeared to qualify because they did not obey the social rules for women at the time; a main indicator of their psychopathy was a lot of extramarital sex.
In the 1970s, Professor Robert Hare, a Canadian criminal psychologist, used the behavioural characteristics of Cleckley’s subjects to devise a measure of psychopathy, the Hare Psychopathy Checklist.5 He applied this to a large sample of prisoners convicted of violent crimes and found that a minority of them, about a third, scored highly on his scale, with key recurrent features, such as lack of emotion and deceitfulness. Their criminal behaviour was extreme in its violence and variety, and they would reoffend more often than those with lower scores. Hare’s work excited tremendous interest and generated studies around the world. The academic field of psychopathy is huge, and ideas are still evolving; the jury is still out on the causes of psychopathy and what we can do about it. The best guess is that psychopathy arises from a complex interplay between genetics and environment, but there’s still more to be discovered about this, I’m sure. I’ve been less interested in the causes than in ideas for the treatment of psychopaths, which first began to appear in the 1960s and 1970s. Evidence began to accrue that people with psychopathy could, if they had at least some capacity for self-reflection, respond well to structured prison programmes that combined group and individual therapy.6 Working with individuals still has to be approached with caution, however, because of the risk of the therapist being conned and exploited.
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By the time I met Tony, almost twenty years after Hare’s checklist was first devised, there was a new twist: some researchers were beginning to question whether psychopathy existed at all, and if it did, whether criminal rule-breaking was a necessary feature of a typical psychopath. The suggestion arose that there could be countless successful psychopaths in our society: those charming, intelligent and ruthless people who are running our banks and other industries or invading smaller countries.7 The complexity here is that this effectively makes psychopathy the same as being tough and exploitative, so it should be a common diagnosis in contemporary cultures like ours. But, at least according to the available data, that does not seem to be the case. It is also unclear to me what applying this label to people achieves if they haven’t broken the law, beyond implying that they are especially mean and nasty, which we knew already.
How might any of this thinking apply to Tony and people like him? By definition, the psychopaths we see in prison and secure hospitals are social failures, not successes, and obviously lack the intelligence to avoid detection. I suspect that the most able criminal psychopaths would never use violence themselves (although they might get someone to do it for them) because doing so jeopardises their welfare. Over the course of my life, the psychopaths I’ve encountered have been neither exceptionally bright nor socially able nor at all charming. They are usually so unempathic that they cannot see the effect they have on others, which is why they end up sabotaging themselves. They are unlikely to ask for therapy because they don’t want to demean themselves by requesting our help – and they think they know everything anyway. On that basis alone, Tony wouldn’t have met the criteria for psychopathy, no matter how many people he had killed.
I expected to work with him over the long haul, gradually building a therapeutic alliance, or what pioneering British psychiatrist and psychotherapist John Bowlby called a ‘secure base’.8 It might take a year before we had the kind of trust that enabled Tony to open up. I decided to return to the issue he had raised at the beginning: even though he’d said that he would rather not talk about his nightmares, I wanted to find out more about the link between them and the problem of the man who shouted. I was fascinated by the idea that Tony might have located himself in the ‘shouting man’, using a psychological mechanism called projection, by which we transfer our uncomfortable feelings or wishes to another person, like an image cast onto a screen. I recognised that I would have to go carefully because projection is a defence that involves distorted ‘reality testing’. This term, which I will return to, describes the ability to distinguish between what is real and what is not, and whether someone can judge and respond to situations appropriately. We all have this faculty, but it is diminished or impaired in those who experience psychosis.
The ‘shouting man’ projection might mean Tony was more unwell than he appeared, and I sensed that his resistance to talking about his nightmares was an indication of the emotional quality and power of the defence. If that wall came down too quickly or abruptly, he might get in touch with horrible feelings that he could not process, and he could become suicidal again. My supervisor and I also talked about whether the nightmares could stand for something else in Tony’s mind, and whether it was possible that ‘the man next door’ represented some idea or person he needed to keep behind a barrier. We discussed how I needed to support Tony and let him go at his own pace, so that he might be able to tell me about the things he most feared. We eventually made some progress when, several months into our work together, Tony told me he was ready to speak about the content of his nightmares.
They were always the same, he began. He was strangling a handsome young man who was attempting to scream, and he had to shut him up. He was increasing the pressure on the throat, seeing the panic and terror in his victim’s eyes and feeling a soaring sense of power, ‘a high’. Suddenly, the young man’s face became his late father’s face, distorted by rage. Tony’s voice shook as he described how it then transformed into a kind of male Medusa head, with snakes framing a terrible angry mouth. In the dream, he always tried to stop the head from speaking, but it would shout at him. The words were indistinct, he said, but he knew it was ‘something sneering and nasty’, and he felt both terrified and frustrated that he couldn’t comprehend their meaning. He felt he had to find out, and that was the point at which he would wake up, in a sweat, his heart racing, and hear the man next door crying out.
This nightmare took us directly into talking more about his offences and his family. I knew some bare facts, but I wanted to hear them directly from him. He began by saying he grew up in a Catholic household with his English father and a fragile, beautiful Spanish mother who was helpless in the face of her husband’s violence towards her and the children. Tony told me he remembered hiding under his mother’s clothes in the wardrobe to escape from his father’s fists, and how he loved the sweet smells and soft fabrics, as a kind of antidote to his father’s abusive masculinity. Sometimes he would try things on or play with her make-up when he was alone, which is a normal part of development, as young people explore what it means to be masculine and feminine. It did make me think about whether Tony had identified more w
ith his mother than his father, but that didn’t seem to fit when he described to me how, as he approached adolescence, he began to despise his mother, rejecting her affection and hating her weakness.
At secondary school, he struggled with self-esteem and thought himself ugly; this was something I would hear again from people who had experienced childhood abuse and neglect, including Marcus, another patient in this book. There have been studies showing how such children will react to their images in a mirror with agitation and hostility. They also tend to have difficulty in developing a ‘social brain’, meaning they are unable to interact well with others and may have persistent problems with mood swings and temper control. It was unsurprising to hear that young Tony did not make many friends in his class. It is often said that quiet, tough children like this – the loners with troubled home lives – are resilient; indeed, that is an adjective which is regularly applied to all children, as if they were hardy plants. It is more accurate to say that a child who has lacked basic nurturing, living in an emotional drought, goes into a state of dormancy, or hibernation. They may detach from the reality of their world to protect themselves, and like a plant under stress from acid rain, or one that is planted in poor soil, their minds cease to grow and flower.
Tony told me that his response to difficulties at school was to start working out, building up his muscle mass. Soon he began to lash out and bully other boys, finding that it aroused him sexually. This association is something I hear regularly from sexual offenders, and it is supported by a wide body of research over many decades. Advances in neuroscience tell us that the areas of your brain that ‘light up’ when you are fearful, aroused or excited are all situated close together and use the same neuronal networks. As Tony talked about the sexual arousal he experienced when he bullied others, I had a sense that it might be a defence mechanism for him: he could feel phallic and strong by making other children feel afraid. He could get rid of his own horrible feelings of fear related to his father by projecting them onto another person. I’ve heard many patients describe something similar, telling me how their violence helped them feel safer and somehow satisfied. While this may be hard for most of us to relate to, we have probably all known at some time a feeling of ‘Schadenfreude’, or satisfaction at someone else’s misfortune, the word literally being a combination of the German words for harm and joy. This, too, is a coping mechanism, a flicker of relief prompted by someone else’s suffering. In Tony’s case, this flicker would become a roaring flame.
Young Tony had sufficient empathy and social awareness to be concerned about these feelings. He was also still ambivalent about his sexual attraction to other men. He told me he knew it would be anathema to his strict Catholic parents, who thought homosexuals belonged in hell. His father called gay males ‘fairies’ and was scathing about any sign of femininity in men. Still, Tony would fantasise about what it would be like to be with another man and to control him – someone who was both beautiful and weak. I thought of his mother and father’s power relationship and the scared little boy who witnessed their interactions through the slats in the wardrobe. When he got into fights at school, Tony told me his father always responded by praising him, saying, ‘Now you’re a real boy.’ It may seem like a long way from the Marquis de Sade to Pinocchio, but the little puppet boy leapt into my mind when he said this. I couldn’t help but think of the love Pinocchio found that made him real and the link with his ‘father’ Geppetto, who gave him life.
When Tony finished school, he wanted to train as a chef. His father disdained this ambition (‘women do the cooking’), and so Tony left his provincial home town, moving to London in the late 1980s. By day, he found work as a waiter in a trendy restaurant, where he thrived. When I was eventually able to locate his trial records, I saw testimony from his co-workers, who described him as popular and diligent, and who were stunned by his eventual arrest for serial murder. By night, he played the hard man in the local gay bars, butch and challenging. He was able to articulate to me that it suited him to oscillate between two identities: the pleasant waiter and the tough sexual predator. As he talked, I visualised his account of how he would end his shift at the restaurant, duck into an alley and ditch his crisp white shirt and apron for the other Tony’s singlet and leather jacket. This reminded me of other serial killers I had read about, who would carefully compartmentalise their cruelty from their everyday lives, an internal split screen that acts as another kind of defence mechanism, which is sometimes known as ‘doubling’. The term was coined by Professor Robert Lifton in his 1986 study of Nazi doctors in the death camps, where he describes how they would have an ‘Auschwitz self’, one that was free of all moral standards, and a ‘human self’ outside the camp, where they were principled, professional family men.9
This split was highlighted by the FBI in a 2008 symposium on serial murder.10 Their research confirmed that contrary to portrayals in countless TV series and novels, these offenders are rarely loners and social misfits. Most of the subjects the FBI experts studied were employed, and they had social lives and families. They were usually described as ‘nice neighbours’ and ‘friendly colleagues’, which reminded me of expert testimony I had once heard about a serial killer that emphasised that ‘he had always paid his taxes’. The good self acts as a double for the cruel alternate self, which is usually hidden, as in the ancient idea of the good person and their evil doppelgänger. The Strange Case of Dr. Jekyll and Mr. Hyde is a classic literary example of this.
In therapy, people tend to bring their better selves to the table, at least initially. I thought it might take time for Tony to reveal what Jung would have called his ‘shadow self’ to me, but it emerged in the sessions quicker than I anticipated. I was at pains to be careful with him but, as happens when one is trying too hard, it was easy to make a rookie error. We were talking about his nightmares again one day, and in that context I asked if we could go back to what he had told me about his father’s ‘abusive behaviour’ – a phrase he had used. I saw Tony’s face darken; his heavy brows came together and he turned a fiery gaze on me. I felt anxious but also confused. I was sure he had described his father’s cruelty in this way, so I had assumed this term was acceptable to him. What I had not understood was that for me to use his words gave them a reality he could not bear; he was too identified with his father, and his words in my mouth had unsettled him. His hands gripped the edge of the table between us, knuckles whitening. I almost flinched, worrying that he was going to upend the table or leap over it. My hand moved, ready to press the alarm on my belt. But instead he got to his feet, threw his chair aside, strode to the door and left, slamming it behind him.
His abrupt departure made the staff worried and cross in equal measure. ‘What happened?’ I sensed they really meant, ‘What did you do to him?’ Patients can sometimes react negatively as part of the process of working with a psychotherapist, and although the nurses know that, they also have to clear up the psychological mess left behind when the therapist goes home. An ‘upset’ caused by therapy might make the patient riskier and more aggressive with staff or other patients, or it could even lead to self-harming. I had to spend quite a bit of time explaining what had transpired and reassuring the staff that nobody was in danger; Tony was just annoyed with me, and annoyance and homicidal risk are not the same.
I wanted to make progress with him, to show that I was a good therapist, or at least had the makings of one if I could just shut up and listen. When I did speak, I would need to become more delicate, more careful with my words. I’d had this pointed out to me before in training, and I had been told it was something which took years of practice and a lot of trial and error. I told my supervisor that I felt a keen sense of disappointment in myself for my failure to ‘mentalise’ or read Tony properly. He pointed out that this was another valuable lesson. We tend to focus on our patients’ inability to mentalise others, because often they will have misread signals from their victims or got into conflict while in custody because they couldn
’t mentalise fellow offenders or staff, but it was worth experiencing how easy a trap this was for anyone to fall into – even a trained therapist. It is a faculty that can be developed and improved, he explained, in therapists as well as in the people we treat.
Tony and I were able to explore this together once his anger abated and he decided he was ready to return for another session, a few weeks later. We agreed that ‘upset’ was necessary for minds to change and grow, and we talked about the dual meaning of the word: making someone unhappy versus knocking something over, thus revealing something new and perhaps uncomfortable underneath. I realised that I needed to let go of wanting to control such upsets. I was able to share with Tony something of what my supervisor had helped me to understand: that we needed to allow our minds to be different and in conflict – it might even be fruitful. I was relieved that my mistake and Tony’s anger had not destroyed our work together, and we resumed our weekly meetings with a new understanding.
Tony continued to narrate his history, and after a few more months we approached the period when the killing began. His first offence had occurred after several years of what sounded like a wild life in the London gay scene. Just as the HIV epidemic was exploding, he started experimenting with all sorts of drugs and multiple sexual partners, living life with a ‘fiddling while Rome burns’ nihilism. He got into the habit of ‘cruising’ on his night off, every Thursday, looking to meet men in bars. He told me he liked younger ones who were ‘pretty’ and ‘needy’. He would entice them by acting gruff at first, and then let them think they had softened him. I had seen his disarming smile and thought his rough charm might be appealing to someone who was looking for masculine love and protection. I thought Tony might have been drawn to younger men who reminded him of his own vulnerability and need for care; perhaps when he killed them, he was killing off that part of himself. I was not surprised when he told me that he had been feeling depressed and suicidal around the time of his first offence.
