Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior (3 page)

Forensic psychiatrists often examine criminal defendants who have committed all manner of antisocial acts, persons 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.

But Stalin did not pull the trigger of each gun, nor did Hitler turn on the gas cock in every extermination room. Were all the enabling participants in their murders mentally ill? Consider Adolf Eichmann, the Nazi bureaucrat who directed the deportation of millions of people to concentration and extermination camps. Even though he had perpetrated unconscionable evil, a half-dozen psychiatrists certified him as normal.

The term
banality of evil
, used by Hannah Arendt in describing Nazi atrocities, refers in part to the infrastructure that subserves genocidal execution. For every paid sadistic functionary who tortures his or her victim, at least 50 “administrators” provide support by answering the phones, driving cars, keeping records, and performing other ordinary, day-to-day tasks. It is just another day at the office. No better example exists of how great evil can be perpetrated by ordinary people, performing ordinary tasks and living ordinary lives. Also appalling is the knowledge that, unlike mass-produced state torture, ordinary individuals devilishly and exquisitely tailor their torture to the intimately known vulnerabilities of their victims, behind the closed doors of millions of workplaces and homes throughout the world.

Many among the Nazi executioners went home after a day of exterminating women, children, and old men to resume quite comfortable and normal lives in the bosoms of their families. They ate good food, listened to classical music, read a refined book, made love with their wives, coddled and embraced their children. How could the mind of an executioner juxtapose an evening of domestic bliss against the atrocities he perpetrated during the day? Was it mental illness that allowed such a duality?

Many murderers and torturers have been facilitated by an infrastructure of compliant, enabling supporters who were in all likelihood certifiably normal. And I stress that in all of the cases of mass killings and sadistic acts such as those of the Nazis, there must have been dramatic failures of empathy and enormous excesses of projection of their own unacceptable thoughts and feelings that permitted the perpetrators to conceive of the victims as detestable, nonhuman objects.

The mental states that permit such immense cruelties evolve out of ordinary psychological processes. For example, an ordinary psychological defense observed in the psychiatrist’s office and in everyday life may shed some light on humankind’s worst inhumanities. The vehement criticism of others, on closer scrutiny, often turns out to be a disturbing self-criticism. It is far easier to see our problems in others than to acknowledge them in ourselves. To look inside and discover unacceptable impulses can be a very troubling experience. For some people it is intolerable. These individuals, and sometimes whole societies, need to attribute their dark sides to others and then dehumanize them as a prelude to victimization.

But these immense cruelties and monstrous acts—and the fact that “normal” people are implicated in them—also force us to think. We must consider the possibilities. Could it be that the evils of this world that are perpetrated by human beings result from an innate, natural, self-centeredness? Might this self-centeredness be the psychological counterpart to the instinct for survival? Might it push us to give greater importance to ourselves and interfere with our ability to consider others as worthy human beings? Could it be that virulent forms of self-centeredness and entitlement can account for the overvaluation of the perpetrator’s self, producing contempt and devaluation of others that becomes the psychological engine for these atrocities and mass killings? If so, then how do people reach that point at which lethal selfcenteredness overrides any tendency to be decent to others? Psychiatric concepts fail us miserably here.