Dangerous Minds

A psychiatrist probes those who have no conscience.

September/October 1999

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Dangerous Minds

Rod Searcey

Most dangerous criminals are what psychiatrists call psychopaths. Does that statement strike you as a diagnosis with predictive or curative potential; a moral truth; a judgment about character; or a mere tautology?

Take perhaps the most vile and notorious of our recent serial killers, John Wayne Gacy. In the 1970s, he tortured, sexually assaulted and dismembered more than 30 young men and buried them under his house in Chicago. Gacy was not legally insane -- he knew his violent actions were fatal and condemned by law and society, and he never reported demons overtaking his will and demanding that he kill. He understood rules and norms; he was simply unwilling to obey them if they stood in the way of his satisfaction. Throughout his life, he showed the capacity to orient himself to reality: he could episodically succeed at school, work and even marriage. On the other hand, he did not kill out of any sense of revenge or purpose, but simply because he wanted to, exhibiting what Coleridge, describing Shakespeare's Iago, called "motiveless malignancy."

In Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Oxford, 1999; $25), Donald Black rightly describes Gacy as an ASP -- antisocial personality -- a euphemistic name for psychopath. Black, '78, a psychiatrist teaching at the University of Iowa, wants to persuade lay readers that the disorder merits recognition as a distinct medical condition -- and that it is not wholly immune to treatment. Black also wants readers to reassess the criminal justice system's treatment of ASPs.

Beyond reviewing the current literature, Black sought out eight middle-aged men who decades earlier had been diagnosed as ASPs. Their life stories tell us something about what the disorder does to the individual, his family and the wider range of potential victims. But although Black neatly summarizes what is known or proposed about ASP -- and does so in readable lay language -- he seems vague and conflicted about interpreting the data. His indecision almost telegraphs the implicit theme of the book: our concept of antisocial personality underscores our broader uncertainty about the moral and political implications of behavioral science.

By Black's reckoning, about 3 percent of the population suffers from ASP; the overwhelming majority are men. It is called a mental illness, yet it is nowhere near -- or even consistent with -- psychosis or schizophrenia. Its distinct identity lies in a pattern of rule-breaking and callous indifference to the lives or interests of others. ASPs range from the most horrifying killers to drunken bums who can't stay in a job or a marriage but never break the law. Most exhibit other nonpsychotic conditions such as alcoholism, attention deficit disorder, depression or manic depression. Some of the treatments for those conditions may alleviate some ASP manifestations, although they never root it out. Like these allied disorders, ASP may have some genetic origins, but the disorder often correlates with childhood abuse or lack of parental attachment. If we think we see less of it among the rich, it is probably because those families can hide or find excuses for the manifestations.

What, then, can we do about ASP? Here Black's ambivalence emerges. He is a sufficiently skeptical scientist to recognize that the condition is famously resistant to cure, only marginally susceptible to alleviation and impervious to anything psychoanalytic that requires moral self-consciousness. Most of his study subjects have acted in destructive ways all their lives, though the frequency and violence of these acts dwindled as they aged. But Black entreats families to recognize the symptoms early and do what they can to offer treatment rather than excuses. Remarkably, he also urges ASPs themselves to seek treatment -- as if such a response does not require the very sort of moral self-consciousness he says they lack!

As for legal implications, Black realizes that the criminal justice system will not allow ASP as a defense -- and he claims to agree with that standard. He insists that those afflicted possess free will and should suffer the consequences of their actions. But if Black is convinced that ASP is a meaningful psychiatric disorder, why is he so generous in his concessions to the criminal justice system? If ASP is in any useful sense a syndrome, then it can be said to "cause" the types of behavior that it comprises. This statement itself is a tautology, but it underscores the key problem here: that we are mixing very discrete categories of discourse -- scientific, legal, moral and even metaphysical -- when we discuss a vague condition like ASP. And though Black seems aware of this analytic problem, he is strangely inclined merely to acknowledge it and then avoid it.

Black does offer a few practical suggestions for criminal justice. Though ASPs are rarely responsive to deterrence and rehabilitation, the system can incarcerate them. But if the only useful purpose of imprisonment is constraint, he logically argues, the length of the sentence should be limited by the prisoner's capacity to do serious harm. And Black stresses that few ASPs are physically dangerous after their late 30s. The book is thus an implicit attack on the absurdly excessive sentences provoked by the demagogic politics of both parties, and on the geriatric prisons such sentences may produce.

Black has adeptly described the assaulters, killers, rapists and even thieves who threaten us and has described a set of common denominators in their patterns of conduct and backgrounds. But in the end, he leaves us with a vexing question: now that we know this, what do we do?

Robert Weisberg, JD '79, is vice provost for faculty relations and the Edwin E. Huddleson Jr. Professor in the School of Law.

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