As many of my readers know, I sometimes watch MeTV and a March post of mine featured a Hawaii Five-O episode which featured a psychiatrist. Well, I recently saw another episode (originally aired in November 1970) in which a psychiatrist was featured, in the video below from “Over Fifty Steal”, psychiatrist Dr. Emerson starting from about 20 minutes into the video.
The character of the star criminal, Lewis Avery Filer, in the episode was played by Hume Cronyn and the Film Editor, Arthur David Hilton, was nominated for an Emmy. Filer makes a second appearance in the episode “Odd Man In,” which you can check out for yourselves.
Now just to warn you, I replaced the YouTube video in the March post because CBS made YouTube take the original down sometime after I published the piece because of concerns about violation of copyright law. This brings me to the point of today’s post, which is about Antisocial Personality Disorder, psychopathy, and deception in general as it relates to what I’m often called upon to do by my colleagues in the general hospital.
I guess I’d better hurry up and get this done…before CBS finds out. Does that make me a sociopath? Remember, I didn’t make these videos!
I’m only half-kidding (although I would not be surprised if this video is also pulled). The April 2015 issue of Psychiatric Annals (“Psychopathy versus Sociopathy: A look into the biology to develop more effective treatments”) was devoted to Antisocial Personality Disorder (ASPD) and there were several very interesting articles, under the guest editorship of Dr. Stephen H. Dinwiddie, MD, currently the Director of the Forensic Psychiatry Division, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University in Chicago.
However, I especially liked Dr. Jan Fawcett’s observations in his introductory editorial. Dr. Fawcett casts some doubt on how much we really know about ASPD and psychopathy by remarking, “Are there ‘successful’ or functioning sociopaths and psychopaths that we are unable to study?” He also highlighted, from his experience interviewing a well-known serial killer (now deceased), John Wayne Gacy, the chilling callousness said to be a cardinal interpersonal feature of psychopaths. Gacy’s icy reply to Dr. Fawcett’s question of how he could torture and kill so many young boys and bury them under his house was, “I don’t see the big deal–I was only getting rid of human trash.”
Incidentally, Gacy was evaluated and diagnosed with ASPD in 1968 by psychiatrists at The University of Iowa Hospitals and Clinics, which you could read about in the book, “Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy),” written by my colleague, Dr. Donald Black, MD.
So where do fictional characters like Lewis Avery Filer from the Hawaii Five O TV show fit in? When I watch the episode, I don’t fear him and the impression conveyed is comical and actually sympathetic to him. Filer is polite and even principled, which is the antithesis of sociopathy. He’s deceptive but not deadly. He’s manipulative but not murderous. He’s calculating but not callous. So you can’t call Filer a psychopath by the terms with which psychiatrists are familiar:
- uperficial charm and “good” intelligence
- absence of delusion and other signs of irrational thinking
- absence of “nervousness” or other signs of psychoneurotic disturbances
- untruthfulness and insincerity
- lack of remorse or shame
- inadequately motivated antisocial behavior
- poor judgment and failure to learn from experience
- pathological egocentricity and incapacity for love
- general poverty in major affective reactions
- specific loss of insight
- unresponsiveness in general interpersonal relations
- fantastic and uninviting behavior with drinking and sometimes without
- suicide rarely carried out
- sex life impersonal, trivial, and poorly integrated
- failure to follow any life plan
What the YouTube video doesn’t clearly convey about Filer is the background motivation for his antisocial behavior, something which a psychiatrist would not be able to do since we’re not lie detectors. He was treated shabbily by his former employer. He was an insurance investigator himself so you can assume he knew a great deal about insurance scams and fraud.
And what does Dr. Emerson, the mustachioed psychiatrist say? He uses the word “melancholy” to describe Filer’s circumstances, which makes us care about him rather than fear or hate him–the usual reaction to sociopaths and psychopaths.
And Dr. Emerson says something else which is essential to understanding the popular impression of psychiatrists in some quarters, “…my degree says ‘psychiatry’ not ‘clairvoyance;’ all I can do is guess.”
While he may be overstating the case, Emerson echoes what I frequently have to do in response to my colleagues’ request to evaluate whether or not patients are not being truthful or even to make judgments about whether or they can be trusted to be good parents. I tell them they need to be careful about expecting too much of my ability to predict what motivates the behavior of most patients. The consequences could be far-reaching and damaging to them.
So what’s the verdict? Is Filer representative of sociopaths? Certainly not; I doubt you’ll find anything in nature representing Filer’s style of criminality. But there’s plenty of real examples out there, including the predatory cyber-thieves currently attacking health care organizations struggling to make the transition to electronic health records. There’s a dark world out there, hiding in plain site, just like Filer.
And what about the Psychiatric Annals issue on sociopathy and psychopathy? Despite it’s promise on the cover about developing more effective treatments–not so much. But it’s still a good read and definitely makes “…a few small cracks to let the light in.”
Black, D. W. (2013). Bad boys, bad men : confronting antisocial personality disorder. New York, Oxford University Press.