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

by Robert I. Simon

  The medical profession, like all others, contains its share of psychopaths. Some run afoul of state licensing boards and lose their licenses; some slip by with only recurrent disciplinary actions and fines. Most get in trouble by exploiting their patients, by providing substandard care, and, frequently, by perpetrating Medicare/Medicaid scams.

  The following portrait of a psychopathic psychiatrist is fictional but draws on a number of real cases for its antisocial characteristics and behaviors:

  Dr. Williams is 42 years old, divorced from his third wife, and under indictment for Medicare fraud. He is a bright man with a good deal of personal charm. He has practiced psychiatry for more than 10 years.

  As the indictment proceeds through the courts, a dossier is assembled on him from many disparate sources, some legal, some professional, some personal. Dr. Williams’s marriages have never lasted more than 2 years. He is not permitted to see the two children from his first marriage because of his ex-wife’s allegations that he physically and sexually abused the children. His second and third marriages were to former patients. Both women now give him a wide berth, seeking at all costs to avoid further involvement with him.

  As he will tell anyone who asks, Dr. Williams became a physician to make money. Medical school was relatively easy for him, despite skipping classes to go drinking, because he cheated on most of the exams. On occasion, he broke into departmental offices the night before examinations to steal copies of them. The medical school disciplined him for drunkenness three times but graduated him in the bottom third of his class. As a specialty, he chose psychiatry because it could be done alone and without the scrutiny of colleagues. In an unguarded moment, he remarked to a colleague that he thought most psychiatric patients were hopeless leeches who never grew up. He obtained patients easily because of his charm, but had little real interest in them unless they were sexually or financially attractive. He dragged out the treatment process for wealthy patients—2- or 3-hour sessions, keeping less monied patients waiting—and sometimes sexually exploited the attractive ones. In a spectacular series of cases that made the front page of the local paper for weeks, he was alleged to have sexually exploited several of his female patients. The cases were settled out of court.

  Healthier patients saw through Dr. Williams’s superficial charm, for soon after initiating treatment they felt the bite of his barely concealed supercilious attitude toward them. They soon left treatment. Patients with low self-esteem would stay and would tolerate his behavior (he sometimes even yawned or fell asleep while a patient was relating a personal tragedy), blaming themselves for being uninteresting. Many of these patients were later exploited by Dr. Williams for sex, money, or both. He followed no particular rational treatment method. He viewed patients as inferior beings who deserved what they got in life. His contempt facilitated the suicides of two of his more depressed patients, but he managed to avoid censure or inquiry into his conduct.

  In fact, Dr. Williams was incapable of understanding the inner life of his patients. He could not comprehend his patients’ conflicts, defenses, or the psychological significance of their developmental history. He had no empathy for their personal struggles. To Dr. Williams, the patients were merely projections of his inner needs—objects to be manipulated for his own gratification. If they could not provide him with praise, admiration, sex, or money, he had no use for them.

  This meant that he had no concept of treatment boundaries. Where he as a doctor began and the patient ended was a mystery to Dr. Williams. And, having no concept of this boundary, he would touch his patients as he pleased, even after some of them indignantly complained and asked him to stop. His appointment schedule was a shambles, his patients frequently irate. Were it not for his long-suffering secretary—a former patient to whom he paid a paltry salary— he would not have been able to manage his practice at all.

  The more agonized the patient’s story, the more boring he found it. His eyes would glaze over as his mind wandered into hedonistic fantasies. He would be unable to sit still for very long or to listen to patients without intruding and inflicting on them stories of his own life, which he offered as uplifting homilies. His stories had a grandiose, fantastic quality that emphasized his accomplishments and the great personal difficulties he had had to overcome to make those achievements. They were all lies, though ones that the doctor half believed. Equally important, they enthralled some patients, who were able to escape confronting their personal difficulties while listening to Dr. Williams’ tales. More often sooner than later, these patients would have to be seen by other psychiatrists because they had been left untreated for so long that they were seriously regressed and in the midst of acute crises.

  Dr. Williams continued to receive referrals because of two personal characteristics. One was his quick wit, which passed for high intelligence, and his great personal charm. However, those few colleagues who came to know him found that the charm ran thin. His contempt was hard for him to disguise if he felt envious of a colleague. There were stories that he had seduced the wife of one colleague and the fiancée of another, both of whom he envied. Referrals also came from other mental health professionals because he was the author of some articles on sexual dysfunction that produced a brief flurry of interest. It was later learned, however, that these were plagiarized from the work of other people and that a number of cases in which he reported treating patients for sexual dysfunction were wholly fabricated.

  Dr. Williams had no friends and few acquaintances outside of his practice. When he was forced to spend time alone in his apartment, he would feel unsettled and have a creeping sense of internal void, a consuming nothingness, a deadness within himself. To escape these feelings, he drank or took tranquilizers until, intoxicated, he fell asleep. He was rarely actually depressed or anxious except at those times when he ran afoul of the law or his profession. One such time was when he was sued for sexual exploitation of a hospital patient.

  Although the sexual misconduct case was settled out of court, it was only the tip of the iceberg. Dr. Williams was a serial exploiter of female patients, a predator who gradually seduced low-esteem patients by manipulating them from his position of professional power. These women were told that having sex with their psychiatrist was an accepted form of treatment. To gain control of some of these women, he would oversedate them, or even addict them to medication. His sexual activities with patients were perverse, involving sadomasochistic practices. He would soon tire of one woman and unceremoniously dump her for another. In some of these instances, the rejected patients would attempt suicide; a few, successfully. Other psychiatrists would be called in to pick up the emotional pieces of the survivors.

  Dr. Williams also exploited patients by involving them in business deals. He would either intrude himself into the patient’s business life when he saw a lucrative opportunity, or he would extract money from patients by involving them in his own poorly thought-out business ventures. Patients invariably lost money, and when they did, he would contemptuously discharge them from his “care.” He manipulated less wealthy patients by getting them to do menial tasks for him, such as cleaning his office, collecting his mail, and getting his lunch.

  The lawsuits, ethical complaints, and disciplinary actions by professional bodies mounted, but Dr. Williams never suffered a single pang of remorse or guilt for any of the patients he had harmed, particularly not for those he had sent to an early grave. Eventually, to make a quick buck, he got involved in a Medicare scam and, after the scam was discovered, was indicted. Knowing he would be convicted, he gave up his license to practice medicine in exchange for a deal that permitted him to stay out of jail and to have only a 6-month suspended sentence. He then moved to another state, which had no licensing requirements for psychotherapists, and set up a new practice.

  Criminal Psychopaths

  Criminal behavior, or adult antisocial behavior, as it is referred to by psychiatrists, encompasses a wide spectrum of conduct and describes normally functioning people enga
ged in making a dishonest living, perhaps out of necessity; those who are driven to criminal behavior out of guilt in order to be caught and punished; and those who are brain damaged, either by birth or by drugs. Narcotics, alcohol, and other drugs that strongly affect the brain are contributing more and more to the rising tide of antisocial behavior. Dr. Dorothy Otnow Lewis, a psychiatric expert on criminal behavior, points out that we need to distinguish criminals with antisocial personality disorder—the psychopaths—from individuals whose criminal behavior is a result of their psychosis, below-average intelligence, or brain damage. Because a large proportion of the criminal population has these latter disorders, it follows that those with antisocial personalities represent only one segment of the criminal population.

  At the far end of the criminal spectrum are those referred to as serial sexual killers. Many are sadistic, sexual psychopaths. They must be distinguished from unfeeling, predatory individuals with sexual perversions who run afoul of the law but are not psychopaths. A lethal mixture exists when powerful sexual and aggressive impulses are combined within an antisocial personality. Arthur J. Shawcross’s murder sprees terrorized New York’s North Country, where he killed 11 women, most of them prostitutes. At Shawcross’s trial, Dr. Park Elliot Dietz, a forensic psychiatrist, reported that he had examined the killer and determined him to have an antisocial personality disorder. Dr. Otnow Lewis, who also testified in the trial, said Shawcross had multiple personality disorder. She also diagnosed brain damage, seizure disorder, and posttraumatic stress disorder secondary to the patient’s Vietnam War experiences and severe early childhood abuse.

  In The Misbegotten Son: A Serial Killer and His Victims, Jack Olsen gives a detailed account of Shawcross’s progression from birth to serial killer. As a child, he was very troubled; he displayed a triad of behaviors that some psychiatrists believe precedes homicidal behavior: fire-setting, cruelty to animals, and bed-wetting. Shawcross also bullied classmates, insulted teachers, and roamed the woods of New York’s North Country with fantasied friends. He was ridiculed by other children, even though he shared his toys and money with them. In school, he achieved top grades and excelled in sports. By doing so, he confounded the psychiatrists who began to examine him regularly after the second grade.

  While serving in the armed forces in Vietnam, Shawcross wrote home letters about his gruesome battlefield experiences. Upon his return to Watertown, New York, he committed a series of arsons and burglaries. Shawcross was arrested and convicted and served 2 years in prison, after which he was paroled in the care of his parents. He then strangled a boy and a girl. After he was caught, Shawcross was able to plea-bargain the offenses down to a single count of manslaughter, for which he was sent to prison.

  Incarcerated, he continued to be a mystery. At Greenhaven, a maximum security prison in Stormville, New York, a psychiatrist described him as a dangerous schizophrenic pedophile who also suffered from intermittent explosive personality disorder. Several psychiatrists could not agree as to whether he would ever respond to treatment. After having served 14 years and 6 months of an indeterminate sentence, Shawcross managed to persuade a parole board to give him an early release. Olsen cites the report of a psychiatrist who examined Shawcross for that parole hearing; the report states that the strangler was “neat, clean, quiet, cooperative, alert,” with “positive attitude,” “no evidence of any perceptual disorder,” “no delusions, no morbid preoccupations, memory intact,” “intelligence good, good reality contact, denies suicidal or homicidal ideation,” “not depressed, not elated, mood stable,” and “not emotionally ill at present.” It is not unusual for sadistic murderers to appear quite normal or even to be model prisoners while they are within the confines and structure of an institution.

  Shawcross attempted to settle in one community after another in upstate New York but was invariably run out of town. Unbeknownst to the Rochester police, Shawcross was smuggled into that large city and soon began stalking prostitutes, generally troubled, diminutive women. Their nude, mutilated, sexually assaulted bodies were found in icy streams and swamps. One prostitute survived her encounter with Shawcross by playing dead so he could achieve a pseudonecrophilic orgasm. Shawcross did perform sexual acts upon some of his victims after they were dead. At his trial, the psychiatrists once again could not agree on an exact diagnosis for Shawcross. However, he was convicted and sentenced to life imprisonment without the possibility of parole.

  Necrophilic sexual psychopaths derive sexual gratification only when they can have complete command of a woman’s body without the woman present. The total sense of power acts as an aphrodisiac but also dispels fears of inadequacy with women. Sexual fantasies involving sleeping women are common among men. In medieval times, demons or spirits called the incubus and the succubus were thought to have sexual intercourse with sleeping women and men. The necrophilic psychopath pursues a much distorted and debased version of this common fantasy.

  The Lady Next Door

  Shawcross was widely reviled as a serial killer and was the object of a massive manhunt. By contrast, Virginia McGinnis operated almost without interference during a criminal career in which at least four people who were near her died. The story began to unfold in the wake of the death of Deana Hubbard Wild, a 20-year-old woman who had been a house guest of McGinnis and her husband. The McGinnises had driven Wild to a 400-foot cliff along Big Sur, California, for a sightseeing trip, and, according to the McGinnises, while their backs were turned, Wild had fallen from the cliff “without a sound.” Wild’s distraught mother, who lived in Louisville, Kentucky, asked a tax attorney to look into her daughter’s death because she needed help in collecting the daughter’s burial insurance. The attorney, Steven Keeney, was amazed to discover that Virginia McGinnis had purchased a life insurance policy on Wild one day before the “accident,” and that the beneficiary was McGinnis’s imprisoned son.

  Suspecting foul play, Keeney investigated further, as detailed in David Heilbroner’s book Death Benefit. Keeney learned that both of McGinnis’s sons had been previously charged with murder, and that they had both been in and out of prison. Moreover, he discovered that three of McGinnis’s relatives had fared badly under the care of this woman, who called herself a practical nurse. Her 3-year-old daughter was found hanged in a barn. McGinnis claimed it had been an accident. Her husband died suddenly one evening while she was nursing him, and so had her own mother. Further inquiry uncovered a series of thefts, fires, and poisonings from which she had reaped the insurance benefits.

  A pattern of antisocial behavior dated back to her childhood. Keeney compiled a 600-page report on her life and crimes. The child of a people-hating dairy farmer, McGinnis was abused in her early years. Ill fed, she lived in filth and smelled of cow manure and kerosene. She had no friends. She became a bully and a juvenile delinquent. She flashed polished paste diamonds to her classmates, then stole their lunches. Like Arthur Shawcross, McGinnis displayed the prehomicidal triad of behaviors: fire-setting, cruelty to animals, and bed-wetting. Brought to trial for Wild’s murder, McGinnis was portrayed by the prosecution as a remorseless killer who beat the system repeatedly in collecting money from the insurance policies of her victims. Evidence was produced about her remorseless, treacherous, sexually promiscuous, glamour-loving behaviors. After watching her for 2 months, the jury dubbed her the “ice lady.”

  The jury did so, writes Heilbroner, because “outwardly she still appeared so normal, the lady next door who efficiently did away with her house guest and who had left a wake of fires and bizarre deaths. In the hours when she drove Deana up to Big Sur, making small talk, smiling like a loving friend, she had countless opportunities to turn around. Instead, she was intent on betrayal.” This description brings to mind Cleckley’s classic depiction of the psychopath’s “mask of sanity.” Indeed, the forensic psychiatric expert consulted by Keeney suggested that Virginia McGinnis was a psychopath. She received a life sentence without possibility of parole. Heilbroner concludes:


  Keeney knew that [this] wasn’t the abstract evil he had studied in the seminary. This evil had a human face and a human heart. It lived next door, smiled as it passed you on the street, and called you neighbor. This evil was woven into the fabric of the human soul. Aragon [the prosecutor] is right, Keeney thought, we are all “of the same fabric.”

  To this conclusion I can only add that the warp and woof of that fabric is different for the bad men and women who do what good men and women only dream of doing. The good boy wishes to trade his bratty brother for a cold soda on a summer day but does not do so. The bad woman does not hesitate to “trade” an innocent woman’s life for the proceeds of an insurance policy. All human beings wish to do the forbidden. Fortunately, the majority of humankind is able to resist these antisocial impulses. And, unfortunately, as the examples in this chapter have shown, psychopaths will be with us forever. We cannot escape the possibility that at some time in the future, a particularly virulent psychopath may become evil incarnate and leave all of humankind for dead.