On April 15, I published a book written with Dave Hall and Tym Burkey about an interesting undercover operative. I also posted a long blog about it at: http://www.leelofland.com/wordpress/?p=517#comment-1457.
I’ve posted my picks for crime movies here:
I’m looking forward to presenting at this conference in February. I’ve been to many places in Seattle, but this is one about which I’ve heard a lot of great things.
The Writers Conference countdown is ticking away! Take a look online at the great preconference workshops. Register by December 5 to receive a discount and reserve your Chat House while you’re at it. Dinner with an Author includes 12 authors and entertainment includes free events at the Whidbey Island Center for the Arts and Whidbey Children’s Theatre. Gift certificates are available in any amount. Check out the conference Web site and register now before that $55 discount flies out the window.
People keep secrets, but it’s the secret they keep from themselves that’s often the most damaging. Patricia Cornwell’s new novel is a sophisticated juggling act of emotional deflection and indirection, which provides a vibrating undercurrent to the plot. Readers who take this story at face value only will have missed the point: there’s a lot more going on than just Scarpetta and gang solving another series of murders. It’s no surprise that cancer is a metaphor of a sickness of the soul from which, to one degree or another, all the characters suffer. As one puts it, you ignore depth psychology to your peril. Despite the fact that “truth is relief,” few people have the courage to embrace it – especially when it’s about them. Cornwell is maturing as a writer, exploring beyond the overt activities of genre formulas to the unwieldy force of powerful emotions that can ambush. The pervasive sense of water seems clearly a symbol of submerged feelings, which, though unseen, can nevertheless direct behavior onto paths of harm and regret. The unregulated arena of the Internet serves a similar function, and readers who spot these metaphors early gain the added pleasure of watching how covert forces move the plot as surely as any character’s actions. For me, the best part was the way good people mirror bad, because it’s a reminder that, under certain conditions, anyone can harm another – even people who love each other. As a result, these characters remain alive for readers as people not props, keeping this impressive series going. I, for one, want to see what happens next.
thebraveone.doc I posted this review at the crime Library.
For those of you who have read “Ghost,” and asked for more. I’ll soon publish “Bethlehem Ghosts,” about ghost stories in my area. I’m posting a picture of the front cover, featuring “der Ausleger,” a phantom undertaker who actually drinks death water!
ramsland-healthcarekillers.pdf
This week, my latest book will be released. It’s called Inside the Minds of Healthcare Serial Killers, which pretty much explains the content. Many people think these cases are all alike, but that’s not the case. Whenever I give my undergraduate students a choice about whether I should talk about doctors and nurses who intentionally kill patients (HCSKs) or some other type of killer, they inevitably pick anything else. Like them, few people realize is just how unusual some of these killers are. They’re not mercy killers, although most claim to be. They generally have other motives, and they’re among the few types of serial killer for whom we can actually do a fairly accurate risk assessment. In retrospect, the red flags were all there.
Among the strangest is Dr. Michael Swango, who pled guilty to several counts of murder in 2000, although we may never know how many people he actually killed. Now here’s a guy who, during medical school and an internship, avidly collected stories about car accidents, deliberately poisoned coworkers, and openly admired Henry Lee Lucas, who he believed had wandered the country killing without consequence. Ted Bundy and Jim Jones were among Swango’s heroes, as was James Huberty, who slaughtered customers at a McDonald’s in 1984. Swango one told a female paramedic he’d like to plunge a hatchet into her head and revealed a violent fantasy to colleagues: he wanted to rush to the scene of an accident involving a school bus and a truck filled with gasoline. Another bus would slam into the truck, causing an explosion and sending kids flying. Nothing excited him more, except perhaps to tell families of patients that their loved one was dead. For him, that was truly erotic.
A few people saw the warning signs, but not most of Swango’s superiors. They kept ignoring the problems and when Swango finally managed to work on patients, a number of them died. He wasn’t called Double-O Swango for nothing – he had a license to kill.
Like many HCSKs, Swango succeeded by moving on from one establishment to another, and even going overseas. It was in Zimbabwe that one of the most bizarre stories emerged about him, as recorded in James Stewart’s excellent true crime narrative, Blind Eye. (It was also in Zimbabwe where his killing career was finally stopped.) He rented a room in a house that provided meals and every morning demanded the same breakfast: two eggs, four slices of toast, and a kilogram of fried bacon. Time passed and one day a servant went into Swango’s room. On a closet shelf she found dozens of neatly wrapped bacon sandwiches piled on top of one another, and in a drawer there were more. He hadn’t been eating all this bacon and bread, he’d been hoarding it – without refrigeration. Bizarre, but fascinating, and very likely related to his desire to kill.
The cases of HCSKs seem to have increased over the past decade and each one has its own peculiar stamp. Although it was my editor who suggested the book, I found that it was certainly a subject worthy of analysis - disturbing as well – and my hope is that what emerged from my study will help make our healthcare facilities safer. At the very least, someone who poisons associates and fantasizes about dead children won’t just be ignored or encouraged to go work elsewhere.
I’m often asked about the difference between a psychopath and sociopath, and it’s difficult to respond because the answer is complex. Many people mistakenly believe the two terms are interchangeable, which is no surprise since both politics and religion have influenced the long evolution of the concept of psychopathy. Thus, I want to discuss why we haven’t designated a single label for a certain type of personality disorder.
It was Theophrastus, a student of Aristotle, who first described this type of person, referring to him as the Unscrupulous Man. He was a liar, cheat, and con artist, without compunction about harming others for his gain. Thus, something was morally wrong with him. (Female psychopaths had not yet come into the picture.)
While psychopathy was the first personality disorder that psychiatry formally recognized in the nineteenth century, it wasn’t easy to crystallize a workable concept for analysis or research. Pinel, a French psychiatrist, used a phrase during the early 1800s that translated as “mania without madness.” He described impulsive people whose actions had negative consequences for themselves as well as others, yet they were fully aware of what they were doing. It seemed a mystery.
In America, Benjamin Rush designated the same behavior as moral derangement and observed that such people develop socially disruptive behavior early in life. In his opinion, they were bad not ill. An English physician, calling it moral insanity, viewed psychopathy as an emotional disorder: These people had criminal tendencies that were not deterred by the idea of punishment.
The actual term, psychopath, first showed up in Germany, during the latter part of the 19th century, but it also covered certain biological disorders, and by the early part of the twentieth century, “constitutional psychopathic inferiority” had become a catchall term for most mental and physical defects. Then brain damage and physiological conditions were placed in another medical category. The next step was to remove ‘constitutional’ from the classification, which still left the unworkably broad ‘psychopathic personality.’ For the percentage of people not psychotic or psychoneurotic who nevertheless caused distress in the community, the most common designation was psychopath.
More psychiatrists worked out ways to refine the concept, but it wasn’t until 1941 that the notion of a psychopath was ably crystallized. Hervey Cleckley published The Mask of Sanity, in which he offered 16 distinct criteria for diagnosis, including hot-headed, manipulative, irresponsible, self-centered, shallow, lacking in empathy or anxiety, and likely to commit more types of crimes than other offenders. They are also more violent, more likely to recidivate, and less likely to respond to treatment.
Now, what about the sociopath? As the concept of psychopathy continued to evolve, the emphasis on assessment in psychiatric circles moved away from traits and toward specific behaviors. To reflect this, some older concepts were renamed. In 1952, in the psychiatric nomenclature, the word ‘psychopath’ was officially replaced with ‘sociopathic personality,’ and both terms were often used interchangeably under the heading of ‘personality disorder.’ Then with the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) in 1968, ‘sociopathic personality’ yielded to ‘personality disorder, antisocial type.’ Such people were impulsive, guiltless, selfish, callous, and unable to learn from experience.
Twelve years later, the DSM-III introduced a list of explicit criteria for psychopaths, but calling it Antisocial Personality Disorder (ASPD). The criteria emphasized the violation of social norms rather than personality traits. However, many researchers were dissatisfied with this new approach because it had no utility.
During the seventies, some researchers ignored the DSM and devised better diagnostic assessments for the traditional notion of a psychopath, as Cleckley had viewed it. Robert Hare and his colleagues in Canada devised the Psychopathy Checklist (PCL-R), with 20 items covering both traits and behaviors. Yet most mental health professionals in the U.S. stuck with the DSM, as if ASPD meant the same thing. But it didn’t. ASPD is a broader category, inclusive of people who would not qualify on the PCL-R as psychopaths, and while some psychopaths might also be diagnosable as ASPD, it would not apply to all people diagnosable as psychopaths. Thus, the terms refer to overlapping but nevertheless different categories of people. (Try saying all of that five times, fast.)
Researchers who followed the traditional idea viewed psychopathy as a disorder characterized by such traits as lack of remorse or empathy, shallow emotions, manipulativeness, lying, egocentricity, glibness, low frustration tolerance, episodic relationships, parasitic lifestyle, and the persistent violation of social norms. According to Hare, “Psychopathy is one of the best validated constructs in the realm of psychopathology.”
Without getting the complex politics surrounding the different diagnostic systems, people who were unaware of the need for precision and accuracy for research and assessment adopted a preference for using either ‘psychopath’ or ‘sociopath’ and came up with their own workable definitions. In other words, things got a little sloppy. I’ve even seen writers use the term ‘sociopath’ but rely on the criteria specific to psychopathy. However, ‘sociopath’ has a different connotation for people who recognize the PCL-R as the best diagnostic assessment.
Which brings me back to the original question: the difference between a psychopath and sociopath. If you subscribe to the Hare criteria for a psychopath, then you see the conning, manipulative narcissistic liar and user as a psychopath, as long as he or she is completely lacking in remorse or empathy. The sociopath, however, is capable of guilt, caring, building relationships, etc., but only within a certain context. He or she will have loyalties to a specific group but not to society at large. They care nothing for social norms and will break them with impunity, if it serves their purpose. So, on the surface, they look just like psychopaths. However, they might genuinely feel remorse over harming someone within their group or family. They will have a moral code of behavior specific to that context: they might not lie, exploit, or manipulate within the group. Thus, they exhibit psychopathic behaviors in certain contexts but not all.
See? I warned you the answer was complex. Does it really matter? In a practical sense, yes. The PCL-R has been proven to be the best predictor of recidivism in criminal populations, and the best predictor of future criminal diversity and brutality. For those who are working with (or writing about) this type of person, grasping their motivational construct can be crucial to understanding what they’re all about…and what they might do in the future. As far as I know, there is no equivalent diagnostic tool for a sociopath.
(First posted on “In Cold Blog”)
