[Paleopsych] NYT: For the Worst of Us, the Diagnosis May Be 'Evil'

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The New York Times > Health > Mental Health & Behavior > For the Worst
of Us, the Diagnosis May Be 'Evil'


    Predatory killers often do far more than commit murder. Some have
    lured their victims into homemade chambers for prolonged torture.
    Others have exotic tastes - for vivisection, sexual humiliation,
    burning. Many perform their grisly rituals as much for pleasure as for
    any other reason.

    Among themselves, a few forensic scientists have taken to thinking of
    these people as not merely disturbed but evil. Evil in that their
    deliberate, habitual savagery defies any psychological explanation or
    attempt at treatment.

    Most psychiatrists assiduously avoid the word evil, contending that
    its use would precipitate a dangerous slide from clinical to moral
    judgment that could put people on death row unnecessarily and obscure
    the understanding of violent criminals.

    Still, many career forensic examiners say their work forces them to
    reflect on the concept of evil, and some acknowledge they can find no
    other term for certain individuals they have evaluated.

    In an effort to standardize what makes a crime particularly heinous, a
    group at New York University has been developing what it calls a
    depravity scale, which rates the horror of an act by the sum of its
    grim details.

    And a prominent personality expert at Columbia University has
    published a 22-level hierarchy of evil behavior, derived from detailed
    biographies of more than 500 violent criminals.

    He is now working on a book urging the profession not to shrink from
    thinking in terms of evil when appraising certain offenders, even if
    the E-word cannot be used as part of an official examination or

    "We are talking about people who commit breathtaking acts, who do so
    repeatedly, who know what they're doing, and are doing it in
    peacetime" under no threat to themselves, said Dr. Michael Stone, the
    Columbia psychiatrist, who has examined several hundred killers at
    Mid-Hudson Psychiatric Center in New Hampton, N.Y., and others at
    Creedmoor Psychiatric Center in Queens, where he consults and teaches.
    "We know from experience who these people are, and how they behave,"
    and it is time, he said, to give their behavior "the proper

    Western religious leaders, evolutionary theorists and psychological
    researchers agree that almost all human beings have the capacity to
    commit brutal acts, even when they are not directly threatened. In Dr.
    Stanley Milgram's famous electroshock experiments in the 1960's,
    participants delivered what they thought were punishing electric jolts
    to a fellow citizen, merely because they were encouraged to do so by
    an authority figure as part of a learning experiment.

    In the real world, the grim images coming out of Iraq -the beheadings
    by Iraqi insurgents and the Abu Ghraib tortures, complete with
    preening guards - suggest how much further people can go when they
    feel justified.

    In Nazi prisoner camps, as during purges in Kosovo and Cambodia,
    historians found that clerks, teachers, bureaucrats and other normally
    peaceable citizens committed some of the gruesome violence, apparently
    swept along in the kind of collective thoughtlessness that the
    philosopher Hannah Arendt described as the banality of evil.

    "Evil is endemic, it's constant, it is a potential in all of us. Just
    about everyone has committed evil acts," said Dr. Robert I. Simon, a
    clinical professor of psychiatry at Georgetown Medical School and the
    author of "Bad Men Do What Good Men Dream."

    Dr. Simon considers the notion of evil to be of no use to forensic
    psychiatry, in part because evil is ultimately in the eye of the
    beholder, shaped by political and cultural as well as religious
    values. The terrorists on Sept. 11 thought that they were serving God,
    he argues; those who kill people at abortion clinics also claim to be
    doing so. If the issue is history's most transcendent savages, on the
    other hand, most people agree that Hitler and Pol Pot would qualify.

    "When you start talking about evil, psychiatrists don't know anything
    more about it than anyone else," Dr. Simon said. "Our opinions might
    carry more weight, under the patina or authority of the profession,
    but the point is, you can call someone evil and so can I. So what?
    What does it add?"

    Dr. Stone argues that one possible benefit of including a
    consideration of evil may be a more clear-eyed appreciation of who
    should be removed from society and not allowed back. He is not an
    advocate of the death penalty, he said. And his interest in evil began
    long before President Bush began using the word to describe terrorists
    or hostile regimes.

    Dr. Stone's hierarchy of evil is topped by the names of many infamous
    criminals who were executed or locked up for good: Theodore R. Bundy,
    the former law school student convicted of killing two young women in
    Florida and linked to dozens of other killings in the 1970's; John
    Wayne Gacy of Illinois, the convicted killer who strangled more than
    30 boys and buried them under his house; and Ian Brady who, with his
    girlfriend, Myra Hindley, tortured and killed children in England in a
    rampage in the 1960's known as the moors murders.

    But another killer on the hierarchy is Albert Fentress, a former
    schoolteacher in Poughkeepsie, N.Y., examined by Dr. Stone, who killed
    and cannibalized a teenager, in 1979. Mr. Fentress petitioned to be
    released from a state mental hospital, and in 1999 a jury agreed that
    he was ready; he later withdrew the petition, when prosecutors
    announced that a new witness would testify against him.

    At a hearing in 2001, Dr. Stone argued against Mr. Fentress's release,
    and the idea that the killer might be considered ready to make his way
    back into society still makes the psychiatrist's eyes widen.

    Researchers have found that some people who commit violent crimes are
    much more likely than others to kill or maim again, and one way they
    measure this potential is with a structured examination called the
    psychopathy checklist.

    As part of an extensive, in-depth interview, a trained examiner rates
    the offender on a 20-item personality test. The items include glibness
    and superficial charm, grandiose self-worth, pathological lying,
    proneness to boredom and emotional vacuity. The subjects earn zero
    points if the description is not applicable, two points if it is
    highly applicable, and one if it is somewhat or sometimes true.

    The psychologist who devised the checklist, Dr. Robert Hare, a
    professor emeritus at the University of British Columbia in Vancouver,
    said that average total scores varied from below five in the general
    population to the low 20's in prison populations, to a range of 30 to
    40 - highly psychopathic - in predatory killers. In a series of
    studies, criminologists have found that people who score in the high
    range are two to four times as likely as other prisoners to commit
    another crime when released. More than 90 percent of the men and a few
    women at the top of Dr. Stone's hierarchy qualify as psychopaths.

    In recent years, neuroscientists have found evidence that psychopathy
    scores reflect physical differences in brain function. Last April,
    Canadian and American researchers reported in a brain-imaging study
    that psychopaths processed certain abstract words - grace, future,
    power, for example - differently from nonpsychopaths.

    In addition, preliminary findings from new imaging research have
    revealed apparent oddities in the way psychopaths mentally process
    certain photographs, like graphic depictions of accident scenes, said
    Dr. Kent Kiehl, an assistant clinical professor of psychiatry at Yale,
    a lead author on both studies.

    No one knows how significant these differences are, or whether they
    are a result of genetic or social factors. Broken homes and childhood
    trauma are common among brutal killers; so is malignant narcissism, a
    personality type characterized not only by grandiosity but by
    fantasies of unlimited power and success, a deep sense of entitlement,
    and a need for excessive admiration.

    "There is a group we call lethal predators, who are psychopathic,
    sadistic, and sane, and people have said this is approaching a measure
    of evil, and with good reason," Dr. Hare said. "What I would say is
    that there are some people for whom evil acts - what we would consider
    evil acts - are no big deal. And I agree with Michael Stone that the
    circumstances and context are less important than who they are."

    Checklists, scales, and other psychological exams are not blood tests,
    however, and their use in support of a concept as loaded as evil could
    backfire, many psychiatrists say. Not all violent predators are
    psychopaths, for one thing, nor are most psychopaths violent
    criminals. And to suggest that psychopathy or some other profile is a
    reliable measure of evil, they say, would be irresponsible and
    ultimately jeopardize the credibility of the profession.

    In the 1980's and 1990's, a psychiatrist in Dallas earned the name Dr.
    Death by testifying in court, in a wide variety of cases, that he was
    certain that defendants would commit more crimes in the future -
    though often, he had not examined them. Many were sentenced to death.

    "I agree that some people cannot be rehabilitated, but the risk in
    using the word evil is that it may mean one thing to one psychiatrist,
    and something else to another, and then we're in trouble, " said Dr.
    Saul Faerstein, a forensic psychiatrist in Beverly Hills. "I don't
    know that we want psychiatrists as gatekeepers, making life-and-death
    judgments in some cases, based on a concept that is not medical."

    Even if it is used judiciously, other experts say, the concept of evil
    is powerful enough that it could obscure the mental troubles and
    intellectual quirks that motivate brutal killers, and sometimes allow
    them to avoid detection. Mr. Bundy, the serial killer, was reportedly
    very romantic, attentive and affectionate with his own girlfriends,
    while he referred to his victims as "cargo" and "damaged goods," Dr.
    Simon noted.

    Mr. Gacy, a gracious and successful businessman, reportedly created a
    clown figure to lift the spirits of ailing children. "He was a very
    normal, very functional guy in many respects," said Dr. Richard
    Rappaport, a forensic psychiatrist based in La Costa, Calif., who
    examined Mr. Gacy before his trial. Dr. Rappaport said he received
    holiday cards from Mr. Gacy every year before he was executed.

    "I think the main reason it's better to avoid the term evil, at least
    in the courtroom, is that for many it evokes a personalized Satan, the
    idea that there is supernatural causation for misconduct," said Dr.
    Park Dietz, a forensic psychiatrist in Newport Beach, Calif., who
    examined the convicted serial murderer Jeffrey Dahmer, as well as Lyle
    and Erik Menendez, who were convicted of murdering their parents in
    Beverly Hills.

    "This could only conceal a subtle important truth about many of these
    people, such as the high rate of personality disorders," Dr. Dietz
    said. He added: "The fact is that there aren't many in whom I couldn't
    find some redeeming attributes and some humanity. As far as we can
    tell, the causes of their behavior are biological, psychological and
    social, and do not so far demonstrably include the work of Lucifer."

    The doctors who argue that evil has a place in forensics are well
    aware of these risks, but say that in some cases they are worth
    taking. They say it is possible - necessary, in fact, to understand
    many predatory killers - to hold inside one's head many disparate
    dimensions: that the person in question may be narcissistic, perhaps
    abused by a parent, or even charming, affectionate and intelligent,
    but also in some sense evil. While the term may not be appropriate for
    use in a courtroom or a clinical diagnosis, they say, it is an element
    of human nature that should not be ignored.

    Dr. Angela Hegarty, director of psychiatry at Creedmoor who works with
    Dr. Stone, said she was skeptical of using the concept of evil but
    realized that in her work she found herself thinking and talking about
    it all the time. In 11 years as a forensic examiner, in this country
    and in Europe, she said, she counts four violent criminals who were so
    vicious, sadistic and selfish that no other word could describe them.

    One was a man who gruesomely murdered his own wife and young children
    and who showed more annoyance than remorse, more self-pity than
    concern for anyone else affected by the murders. On one occasion when
    Dr. Hegarty saw him, he was extremely upset - beside himself - because
    a staff attendant at the facility where he lived was late in arriving
    with a video, delaying the start of the movie. The man became abusive,
    she said: he insisted on punctuality.

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