by Suruthi Bala
In most countries, professionals aren’t allowed to diagnose antisocial personality disorder in someone under the age of 18. But if it can’t be labeled, then how can it be treated effectively—especially when, according to Dr. Marshall, early intervention is key?
Professionals who advocate against the early labeling of children with terms like “psychopathic traits” or “pre-psychopaths” are worried about the stigma it may cause. Another problem is that almost all children exhibit some degree of antisocial behavior sometimes. They can be hostile, disobedient, and verbally and physically abusive. But what happens when these behaviors clearly cross a line? We spoke with a couple who reached out to us after listening to our podcast for years. Cassie and Mike have a teenage son, Arthur, who exhibits serious behavioral issues, such as violence against others, animal abuse, a lack of remorse, and callous, unemotional traits.
Arthur’s behavior has followed a troubling trajectory throughout his childhood. He threw a neighbor’s kittens against a wall, he would catch and kill rats for fun, and he once sent a video to his mom of him smashing live crabs with a screwdriver while laughing. From an early age, his behavior began to spiral—Arthur faced being expelled from school at just age four, but this didn’t rein in his behavior. By age 10, Arthur had taken a knife into school with the intention of attacking another pupil. At age 12, he was inappropriately touching other children at school and eventually sexually assaulted another student. Arthur wasn’t any better at home. He would stand silently in his parents’ bedroom doorway at night and watch them sleep. Arthur also began to exhibit inappropriate behavior toward his younger sister and his mother. He started to compulsively watch hardcore pornography, he tried to drown his sister, and he even began making strange videos, almost like a manifesto.
Eventually, Arthur was placed in a children’s care home, where he remains today at age 14. He regularly threatens and assaults staff emotionally, physically, and sexually; he even once attempted to induce an anaphylactic reaction in one of the caregivers after learning about her life-threatening allergy. Arthur runs away at any opportunity and is completely resistant to therapy. He says to his psychiatrist that in sessions he just tells him what he knows he wants to hear. Arthur shows no remorse, has no empathy, accepts no responsibility, and believes that everyone else is in the wrong for not letting him do as he wants.
Arthur is clearly displaying incredibly worrying signs and has almost since birth, but he cannot be diagnosed with antisocial personality disorder until he is at least 18—right around the time that he will be released from the children’s home to integrate into society. Now don’t get us wrong—exhibiting a conduct disorder and limited pro-social emotions in childhood isn’t a definite path to a life of violence, but it does put that child at a greater risk of developing adult psychopathy and getting into trouble with the law in the future.
The Sorrow of the Psychopathic Child
So, what has Arthur been diagnosed with? The interesting thing is that many children like Arthur, who at a young age show conduct disorder and psychopathic traits, are generally diagnosed with and being treated for ADHD (attention deficit hyperactivity disorder), because they can’t be diagnosed with ASPD. But in some cases, when for example the true cause of the behavioral issues is psychopathy or ASPD, this could be tremendously detrimental, because although these children will usually present as overactive, ironically they have the underactive brain of a psychopath, making ADHD medication the opposite of what they may need.
As we discussed in chapter 1, the brains of psychopaths are different. The prefrontal cortex is almost completely switched off and it shows very low levels of arousal to stimuli. These children who perhaps have psychopathic or non-pro-social traits have a severe inability to concentrate and so they fall behind in school; this is not an indicator of low intelligence, but as they fall behind their peers, they develop a low self-image. Unfortunately, this breeds frustration and further pushes the child to defy authority.
The growing negative self-perception then leads these children to do things that will give them immediate gratification. Thanks also to their less active prefrontal cortexes, these children seek excitement and stimulation from more and more extreme behavior in order to get their brain arousal levels to reach “normal.” They will act on impulse, usually in a destructive and not-so–socially acceptable way. This kind of behavior will cause other children to become cautious of them and distance themselves, but the child with psychopathic traits will usually struggle to recognize emotions in others’ faces, again hampering their ability to form a bond or to correct their behavior. This rejection compounds the child’s negative perception of themselves and increases their feelings of isolation. The loneliness, coupled with a lack of normal social or academic achievement, plus the thrill-seeking behavior they use to light up their underactive brains, often culminates in criminal behavior.
If we did screen children for psychopathy early, would treatment work? We discussed in chapter 1 how psychopaths who have already committed a violent crime can be rehabilitated more effectively, but what about a child displaying psychopathic tendencies? Well, the evidence shows that treatment—in the shape of specific kinds of therapy and medication—can work, and the earlier it starts the better. But let’s be clear, it’s not so much a cure as it is an adjustment. A child doesn’t have to grow up to become an active psychopath if they can learn to adjust to society and to control their urges. The psychopathy itself can’t be eradicated, but the child can be made “functionally successful.” Before you grimace that maybe this all sounds a bit Clockwork Orange-y, think about it: The psychopath is not happy or leading a fulfilling life—leave aside whether they are societally “good” or not. Treatment can help them manage their condition, and the byproduct is that they can go on to become a more productive (and less potentially dangerous) member of society.
The problem is that most children like this will not get the support or treatment they need, even though treatment at an early stage has been shown to be far, far, far cheaper for society than the impact if they do go on to offend in the future. Some studies, as assessed in the 1995 documentary The Dangerous Few, estimate that treatment would be about 1/1000th of the cost of incarceration as an adult, and that doesn’t even take into account the lives that could have been saved.
There is no clear-cut solution to any of this, but we think that as a society we should definitely have more open conversations like the one that Dr. Marshall is proposing. But we also understand why this topic makes people uncomfortable and why any truly definitive action could be very difficult in practice.
3
INSANITY
Cacodemonomania, Culpability, and Christ-themed EDM
WHEN PEOPLE HEAR ABOUT HORRIFIC MURDERS, THEY almost automatically jump to say that the killer must have been insane. It’s easy to understand why. But what does that actually mean?
Do they think that all murderers must have had a mental illness that made them kill? If so, that’s not really the story statistics tell. Study after study on people who have committed violent crimes shows that the majority of killers exhibit no evidence of severe mental disorders. Dr. Michael Stone, a forensic psychiatrist at Columbia University, has collated a detailed database of mass killers dating back one hundred years. In 2017, he concluded that about 65 percent of them did not have a diagnosable mental disorder. According to Dr. Stone, the majority of the killers are angry, and they act on a deep sense of injustice that built up over time. They are not mentally ill.
Yet the notion that mental illness and criminality, especially murder, are inextricably linked is pervasive. We’ve even colloquially adopted a lot of clinical terminology, but unsurprisingly these words are often thrown around completely incorrectly. How often have you heard a person call someone else a psycho? Or heard the term schitzo being bandied around? The person doing the name calling here is probably referring to a person who is constantly changing their behavior or their temperament and is perhaps prone
to mood swings.
According to the DSM-5, which is currently the key diagnostic tool used by mental health professionals, these wouldn’t be anywhere near the symptoms of someone with schizophrenia. What they probably mean is dissociative identity disorder—formerly known as multiple personality disorder—yet symptom-wise they’d still be wrong anyway.
These misuses of clinical terminology highlight the continued stigma of mental illness, so it’s important to say straight off the bat that people who suffer from mental illness are much more likely to be victims of crime than perpetrators of it. And people with untreated severe mental disorders are much more likely to be a danger to themselves, not others. The vilification of mental illness when it’s presented as the sole reason why killers kill is at best overly simplistic, and at worst ignorant and dangerous.
A lot of the bias and misunderstanding around the issues of insanity is—in our opinion—largely due to the fact that we are absolutely inundated with TV shows, movies, and books that are obsessed with the concept of “the insanity defense,” or “not guilty by reason of insanity.” In reality, this highly contentious defense is used in the US less than 1 percent of the time! And it’s only successful in a quarter of that 1 percent of cases. It is an exceedingly rare defense, and it’s rarer still that it works, because there is an incredibly high bar to meet at trial.
So, because there is a huge amount of misinformation out there about what insanity truly is (for example the fact that it is not a clinical term, but actually a legal and cultural one)—we’re going to have to be on top of our game this chapter to keep up with the tangled web of definitions and legal standards—let’s go over the basics. Firstly, even if a killer does have a mental disorder, this does not, we repeat does not, equal insanity. Mental illness is a prerequisite for the insanity defense, but, like the sizes at Zara, it simply is not enough.
As clinical psychologist Laurence Miller puts it in his 2012 textbook Criminal Psychology: Nature, Nurture, Culture: “The mere presence, absence, or severity of any mental disorder does not by itself make a legal determination of insanity. Just because you’re ‘crazy’ doesn’t mean you didn’t know what you were doing.”
The specific rules around the insanity defense are crazy (pun very much intended) complicated and have evolved over time. So, to decipher these rules, we’re going to compare and contrast two cases that from the outside look very similar: the cases of Andrea Yates and Susan Smith. Both involve a mother killing her children; both women drowned their children; both women suffered from mental illness and had previously tried to kill themselves. And, both defense teams attempted to use a not guilty by reason of insanity defense. Yet the legal outcomes were worlds apart.
To compare these cases, let’s first consider the murders each woman committed, then the women’s backgrounds leading up to the crimes, and finally, we’ll analyze both of their insanity defenses.
The Murders
ANDREA YATES
On June 20, 2001, Rusty Yates was at work when he received a call from his wife, Andrea. “Come home, it’s about the kids.”
Rusty was confused. “Is there something wrong with them? Which ones?”
To which Andrea replied, “All of them.”
Rusty rushed home, but when he arrived, he froze in fear at the sight of police cars surrounding his house. Before Andrea had phoned Rusty that day, she had called the Houston PD to tell them that she had killed all five of her children.
When the police arrived, the 37-year-old former nurse was calm; she let them in and told them again that she had killed her children. With that, Andrea Yates sat down on the couch in the front hallway with a disconnected, faraway gaze in her eyes and stopped speaking altogether. The house was dead silent. The officers at the scene started walking from room to room. They had no idea what they’d find; here was a woman who had confessed to something unbelievable, and then had become completely unresponsive. This was like no situation they had ever encountered.
The first responders made their way through the house, and finally one officer entered the master bedroom. On the bed he saw what he thought was a doll peeking out from under the sheet, but when he pulled down the covers, he was aghast. Four little bodies lay side by side. The officer who made the discovery was in a state of shock, but he noticed that the children’s bodies were soaking wet, and instinctively he walked into the bathroom. Here he found another child’s body floating face down in the bathtub. Andrea had drowned all five of her young children.
Rusty didn’t yet know this, but he did know that something was very wrong because the police wouldn’t let him in. He was outside his house banging his fists and screaming at Andrea, “What have you done?” over and over again. All the while, on the other side of the door, Andrea just sat there staring with the same blank look on her face. The police were at a total loss; it’s not often that women kill their own children and it’s even less common that when they do, they just sit there silently waiting to be arrested.
The police took Andrea into custody. Once at the station, she gave an 18-minute-long confession during which she spoke mainly about the devil and hell, saying of her children, “Maybe in their innocent years God would take them up to be in heaven.” Throughout her confession, Andrea remained entirely calm.
When asked during her psychological evaluation, “If you hadn’t taken their lives what would have happened?” Andrea told doctors, “They would have continued stumbling and ended up in hell.”
As you can see, the case of Andrea Yates is a bizarre and heartbreaking one, and it only gets sadder and stranger as we take a look at Andrea’s history and the years leading up to that dark day. But before we go there, we’re going to leave Andrea for the moment and hop over to the small town of Union, South Carolina and to Susan Smith.
SUSAN SMITH
At around 3:30 p.m. on October 25, 1994, 23-year-old Susan Smith left Conso Products, where she worked as a secretary. She went to pick up her two sons, three-year-old Michael and 14-month-old Alexander. She returned home with the boys at 6 p.m. She fed the kids dinner and then sometime between 7:30 p.m. and 8 p.m. she strapped both children into her black Mazda Protege and went for a drive. Soon Susan was banging on the door of a house near the John D. Long Lake. (A lake named after Ku Klux Klan member and State Senator John D. Long… cool.) Susan was hysterical; the family at the house called 911.
When the police arrived, Susan told them that she had just been out for a drive to visit a friend and then to go to Walmart. On the way, she was stopped at a traffic light when, according to Susan, a Black man threatened her with a gun. She claimed that he broke into the car, jammed the gun into her ribs, and told her to drive or he’d kill her. Sobbing uncontrollably, Susan explained that the mystery man had made her drive out of town for about 10 minutes, all the while with the gun in her side and with her kids screaming in the back. Eventually they reached the access road to the lake where the man told Susan to get out of the car. She said she pleaded with the man to let her get her sons, but he drove off with the kids still crying in the back of the car.
The report of a Black man kidnapping two white children in South Carolina meant a massive search for the carjacker kicked off immediately. Roadblocks went up and cars everywhere were being stopped and checked. Susan was inconsolable and the residents of Union were heartbroken for her and her family. Over the following nine days, the police searched everywhere but found nothing. There was no trace of the mystery assailant, Susan’s car, or her kids.
Susan spent her time making tearful appearances on television begging for the return of her children. She even worked with a police sketch artist—a composite drawing of the suspect was broadcast nationwide. But soon the police started to have their doubts about Susan. In the book Sins of the Mother, Maria Eftimiades explains how suspicions began to arise when police realized that Susan’s description of her attacker was super generic and also the friend she said she was going to visit hadn’t even been at home that day. And although
most of the time Susan seemed hysterical, when investigators looked at her closely they weren’t sure they could see any real tears.
Susan also failed a polygraph test, which raised some major police eyebrows. But if you’ve ever listened to our podcast, you’ll know that we don’t put much stock in lie detectors or polygraphs because they just don’t work. (Want to know why? See the sidebar below.)
THE BIG LIE DETECTOR LIE
Lie detectors, also known as polygraphs, don’t work because there is no universal physical or physiological response to deception, so how could a machine possibly measure it? Psychology professor Aldert Vrij at the University of Portsmouth, who is an expert on this topic, told the BBC in 2018, “It [the lie detector] does not measure deception, which is the core problem.” Polygraphs look out for increased sweating, an elevated heart rate, and erratic breathing, but none of these responses are indicative only of lying; there could be so many other reasons for them.
Rather than being signs of deception, these responses are usually just signs of stress. So giving someone who has just been through a stressful or traumatic experience a polygraph is pointless. Finally, some people aren’t stressed by lying, even if they have done something horrific and are being questioned by the police. Someone with psychopathic tendencies, for example, is very unlikely to have a stress-related physical response when lying or deceiving (or waving back at someone who wasn’t waving at them). So lie detectors should probably just get in the bin.