Psychology Today Blogs - Evil Deeds

Messiahs of Evil

Dr. Stephen A. Diamond, Ph.D. — Thu, 15 May 2008 23:13:33 -0700

My most recent post, The Trauma of Evil, addressed the psychological, philosophical and spiritual trauma devastating disasters like Hurricane Katrina, the cataclysmic Indonesian tsunami, the recent killer cyclone in Burma--and now, the massive earthquake in China, resulting in an estimated 50,000 dead or buried alive under rubble--leave in their tragic wake. Such incomprehensibly catastrophic events can, as I said, be viewed as forms of natural evil or "acts of God," as they are frequently referred to. Are they divine punishment, as some religious leaders contend? The work of Satan? A cyclical part of the eternal cosmic process of creation and destruction? Or just random, meaningless natural phenomena?

Next I want to further explore a specific variety of human evil: evil deeds, deliberate destructiveness, and man's monstrous inhumanity to man caused not by nature or God or Satan, but by infamous cult figures such as Adolf Hitler, Charles Manson, Jim Jones, David Koresh and others--including notorious 9/11 ringleader Osama bin Laden. In the next few posts, I'll be taking a look at the dangerous states of mind of these charismatic madmen and their fanatical followers, and the messianic psychology I believe many, if not all, cult leaders share in common. What is the psychology of such mass evil? Can perpetrators of such evil deeds be reduced to some standard psychiatric diagnosis? Or should human evil, as psychiatrist M. Scott Peck (1983) precariously suggested, "be defined as a specific form of mental illness and ...subject to at least the same intensity of scientific investigation that we would devote to some other major psychiatric disease"? It is vitally important for us to better understand the nature and psychology of human evil. As C.G. Jung (1963) warned more than forty years ago, "Today we need psychology for reasons that involve our very existence. . . . We stand face to face with the terrible question of evil and do not even know what is before us, let alone what to pit against it." The pseudoinnocence of denial--see no evil, hear no evil, speak no evil--and the naïve inability or unwillingness to recognize the reality of evil, renders us more susceptible to it.

Osama bin Laden, in particular, may be one of the most dangerous men alive (assuming he's not dead), occupying a prime position from which to trigger World War III. The stunning terrorist attacks on New York, Washington, Madrid and London by violently hateful militant Muslim extremists have been characterized by many as unprovoked acts of evil. Indeed, there are those savvy observers who argue that World War III--an inexorable global clash between radical Islam and Judeo-Christian or secular Western culture, each side perceiving the other as evil incarnate--is already afoot. What makes someone like renegade Saudi millionaire-turned-international terrorist and would-be-exterminator of Western civilization Osama bin Laden tick? Might he display some specific mental disorder? Pathological narcissism? Paranoia? Sociopathy? Psychosis? Depression? Mania? Or is he another religious cult leader with a major messiah complex? Stay tuned for Part 2 of this post.

The Trauma of Evil

Dr. Stephen A. Diamond, Ph.D. — Thu, 08 May 2008 09:51:38 -0700

What are the psychological effects of massive disasters like this week's cyclone in Myanmar (Burma) that may have claimed as many as 100,000 victims? The 2004 Indonesian earthquake and tsunami in which more than 200,000 perished? Hurricane Katrina? The recent mid-west twisters destroying property and killing eleven people? For many of those who barely survive such events, cheating death, the symptoms of acute stress disorder or posttraumatic stress disorder will likely be present, requiring some therapeutic intervention. What are the psychological, theological and philosophical issues victims of such tragedies struggle with? And what about the rest of us who witness such terrible suffering even from afar? Are we immune? How do catastrophic phenomena affect the human psyche? What are the emotional, existential and spiritual consequences of cataclysmic events such as cyclones, floods, famines, fires, hurricanes, earthquakes, tornadoes, and other so-called acts of God?

Let's first make a distinction between natural evil and human evil: While, as a forensic psychologist, I generally write in this blog about evil deeds--human destructiveness-- now we are speaking about nature's own evil. Evil is an existential reality, an inescapable fact with which we all must reckon. (I discuss the controversial notion of evil in Chapter 3, "The Psychology of Evil," in my book Anger, Madness, and the Daimonic: The Psychological Genesis of Violence, Evil, and Creativity.) Virtually every culture has some word for evil, an archetypal acknowledgment of what Webster defines as "something that brings sorrow, distress, or calamity . . . . The fact of suffering, misfortune, and wrongdoing." We see human evil every day in its various subtle and not-so-subtle forms. But when evil strikes in suprahuman, transpersonal, cosmic occurrences such as drought, disease, and tragic accidents that wreak untimely death and destruction on multitudes of innocent victims, how do we make any sense of it? The biblical Book of Job addresses just this subject, as do major religions worldwide. Psychotherapists and mental health workers such as Red Cross counselors who deal with victims of evil are confronted daily with these profound questions: Why is there evil? Where does it come from? If there is a God, how could he or she condone it? Why me? Or why not me, as in the case of "survivor guilt."

Most of us try hard to deny or avoid the reality of evil: See no evil, hear no evil, speak no evil. Or we attempt to neutralize it, dismissing evil as maya or illusion, as in the Hindu and Buddhist traditions. It is tempting to deny the reality of evil entirely, due to its inherent subjectivity and relativity: "For there is nothing either good or bad, but thinking makes it so," says Shakespeare's Hamlet, presaging the cognitive therapies of Albert Ellis and Aaron Beck.

But, even for the emotionally detached, spiritually enlightened or geographically distant observer, the grotesque spectacle of natural evil can be subtly traumatic. This is especially true for individuals with a history of previous trauma. Patients suffering from ASD or PTSD are initially in a state of emotional shock or psychic numbing, as psychiatrist Robert Lifton termed it. They have been precipitously exposed to either natural or human evil, or both, and unable to psychologically process the experience. Denial is no longer a viable defense. They feel out of control, victimized, helpless, powerless, frightened, disillusioned. Often, they also feel angry about what has happened. Angry at god. Or with fate or life itself. They have abruptly been stripped of their childish belief in life's inherent fairness. Their Weltanschauung (worldview) has been shattered. Many will never be the same. Like Humpty Dumpty, the bits and pieces cannot be put back together exactly as they were. Rather, victims of evil must somehow reconstruct themselves anew, psychologically assimilating this devastating experience and its implications into a more mature, realistic Weltanschauung, a reconstructed, sturdier, more flexible platform or foundation upon which to stand in life--one which can withstand, accept, and even embrace the existential facts of anxiety, suffering, disease and death. A revised worldview which recognizes and honors what philosopher Alan Watts called the "wisdom of insecurity." Perhaps one with a more realistic religious or spiritual outlook, such as Job's transformed recognition of god or Yahweh as the ultimate source of both good and evil; or a more sophisticated psychological understanding of the non-dualistic concept of the daimonic in psyche and nature.

These existential, philosophical and theological questions run deep, and can be consciously or unconsciously stirred up by such unsettling events. Natural disasters psychologically shake the very ground of our existence, causing us to question the fundamental nature and meaning of life--and death. They force us, in the starkest possible way, to face the existential fact of life's slender, tenuous thread: that being can at any moment become non-being; that death is always but a breath away; that the basic structure we daily depend upon for meaning and safety is in reality transitory and fragile. Such calamities can sometimes lead to precariously dangerous states of mind: depression, nihilism, panic, even psychosis. They can negate one's sense of security and predictability, leading to severe anxiety states. And they can rattle our religious faith, resulting in despair and, sometimes, even suicide. So it is imperative that psychologists are properly prepared to address such philosophical and spiritual issues in ways which will help victims courageously face and deal constructively with the perennial problem of evil: evil of both the human and natural variety.

Refreshment from Freud's Faucet: A Birthday Salutation

Dr. Stephen A. Diamond, Ph.D. — Mon, 05 May 2008 10:13:28 -0700

My own approach to psychotherapy, developed over three decades of clinical practice, can best be described as existential depth psychology: a (for some, unlikely) fusion of existential psychology (especially that of my former mentor, existential psychoanalyst Rollo May) and the psychodynamic depth psychology (Tiefenpsychologie) of Freud, Jung, Adler, Rank, et al. While I would consider myself theoretically and practically more a Jungian than Freudian psychologist, Freud's writings influenced me profoundly from a very young age. As a somewhat intellectually precocious child, I started reading Freud--whose birthday is tomorrow, May 6-- around the age of twelve or possibly even earlier. It was Sigmund Freud's fascinating, flowing, lucid and penetrating prose that inspired me to later pursue a career as a psychotherapist, following brief flirtations with medicine, art, acupuncture, and more enduringly, music in my teens. By the time I turned twenty-six, I was a fully licensed mental health professional practicing in the San Francisco Bay Area.

Two decades later, during my 40's, I was fortunate to be able to spend most of my summers traveling around Europe, sometimes studying, teaching or lecturing there. In the summer of 1999, I was invited to speak about my book, Anger, Madness, and the Daimonic, at the Second World Congress for Psychotherapy in Vienna, Austria, Freud's hometown. (Freud was born in Freiberg, Moravia, now the Czech Republic, in 1856, but his family moved to Vienna when he was three.) The admittedly Freudian-sounding title of my talk was "Myths of the Unconscious." Vacationing, as was my luxurious habit then, in Kusnacht--the impossibly beautiful Swiss lakeside village where C.G. Jung lived and practiced and the quaint location of the C.G. Jung Institute, where I had both previously studied and taught-- I decided to take the scenic ten- hour- train-ride from Zurich to Vienna. Once settled in the romantic city, prior to delivering my lecture, I set out to visit Freud's former residence and office on Berggasse 19 in Vienna‘s ninth district, now the Sigmund Freud Museum. It was mid-summer, with unusually high temperatures and humidity, even for that torrid time of year. I unwisely walked a considerable distance from my hotel to find Freud's apartment in the mid-day swelter, sweating profusely. Finally I arrived at the unassuming but architecturally ornate apartment building in which Freud and his family lived from 1891 through 1938 before forced to flee to London from the Nazis, and where he first analyzed recumbent patients on his now famous couch in the formative days of psychoanalysis.

By the time I climbed the stairs and entered the impressive second-story apartment, I was parched and dehydrated by the heat. Stepping through Freud's restored waiting room for patients--and where members of the Vienna Psychoanalytic Society, Freud's famous "inner circle," met every Wednesday evening--and approaching the minimal museum staff, I inquired as to whether it would be possible to purchase a bottle of water. They apologetically informed me that the museum did not sell bottled beverages. We were standing just outside of Freud's original kitchen, which was totally off-limits to visitors, while having this mundane interaction. Apparently taking pity on my overheated condition, a compassionate female staff member stepped into the kitchen and returned with a glass of tap water--the very same water from the very same faucet from which Freud drank during the dawning days of what we today more generically refer to as "psychotherapy." Sigmund Freud's "psychoanalysis" is the seminal fount from which all modern psychotherapy more or less springs. (Actually, it was Otto Rank, one of Freud's closest disciples, who popularized the term psychotherapy, and even today‘s ubiquitous cognitive-behavioral therapy was created by a psychoanalyst.) This simple act of kindness and its heady historical context seemed deeply meaningful for this once pubescent imbiber of Freud's prodigious insights some thirty years earlier. Both as an inquisitive boy, and many times thereafter, Herr Doktor Freud had once more furnished much-needed nourishment to this thirsty admirer, perennial refreshment from Freud's faucet.

Sympathy for the Devil Made Me Do It?

Dr. Stephen A. Diamond, Ph.D. — Fri, 02 May 2008 18:59:41 -0700

At the time of her infamous crime, Andrea Yates was a devout Christian, devoted wife, and dedicated mother of five biblically named children--Mary, Luke, Paul, John and Noah-- ages 6 months to 7 years old. She had given up her career as a nurse, deciding, with her husband's support, to be a full-time mother and to home-school her children. All seemed to be going fine at first. But after the birth of her first child began her gradual descent into hell.

Andrea became increasingly sad and despondent. The birth of each of her subsequent four children exacerbated her symptoms, and she was eventually diagnosed with postpartum depression. She felt convinced she was a terrible mother, deserving of punishment. "I think the Devil's in me," she confided to her brother. Fearing that her children "weren't developing correctly," she started to have thoughts about killing them to save their mortal souls: "They were not righteous," she felt, and would surely burn in hell if she did not terminate their still young, innocent lives.

Andrea concluded that her murderous thoughts toward her children must be from Satan, that she had been possessed by the devil. She made several suicide attempts in a desperate, instinctive attempt to protect the children from herself. Psychiatric treatment--consisting primarily of various combinations of antidepressant and anti-psychotic drugs with some very brief cognitive therapy-- provided some tenuous stabilization. However, when her father died, her condition deteriorated, resulting in hospitalization and a new diagnosis of schizophrenia.

On June 20, 2001, Yates fulfilled her filicidal fantasy: Left alone at home with her children while her husband Rusty was at work, she systematically forced each of her offspring face down into a bathtub filled with water, one after the other, holding their heads beneath the water as they struggled vainly for life, until each had died of deliberate drowning. She then dialed 911.

In jail, Yates was once again psychiatrically evaluated, bipolar disorder being the latest diagnosis. Charged with multiple murder, she went to trial in 2002, pleading not guilty by reason of insanity. As in the vast majority (75%) of cases invoking the insanity defense, she was found guilty, and sentenced to life in prison. But Dr. Park Dietz--a famous forensic psychiatrist and expert witness for the prosecution who opined that Yates was not legally insane and therefore responsible for her evil deeds--told the jury what later turned out to be an untruth regarding her likely motivation. The conviction was promptly appealed and overturned in 2005. In her second trial, Yates was found not guilty by reason of insanity. Now 40, she remains confined to a locked psychiatric facility.

What possessed Yates to kill her own children? Motivations vary from case to case. ( I presented another recent case of filicide by drowning in a previous post.) On one hand, she suggests she was moved by love: To spare her children "eternal damnation," she had to save their souls by ending their lives. This implies she believed she was doing good, not evil. On the other hand, she told police in her confession: "I realized that it was time to be punished...for not being a good mother," and that she did what she did because she wanted the criminal justice system to punish her. This sounds like she knew what she was doing was illegal, evil or wrong, clearly understanding and desiring the negative consequences.

Yates, a perfectionist with a long history of bulimia, evidently suffered from pathological guilt regarding herself and her performance as a mother, and masochistically sought castigation. But whether or not she fully comprehended the quality and nature of her deeds and believed her behavior to be wrong at the time the crime was committed--the fundamental litmus test of legal insanity--where did these seemingly unthinkable thoughts come from? From whence springs such evil?

When asked why she had killed her own children, she allegedly stated it was "because I didn't want them tormented by Satan like I was." "It's something I was told to do...to kill them," she said, speaking of the devil. "I felt like he was inside me giving me directions...about harming my children." Was Yates possessed? And if so, by what? If she believed it was the Devil egging her on, why then did she do his evil bidding?

It is not unusual for religious or spiritual individuals to deny or repress the daimonic: sexual, angry, aggressive, hostile or other impulsions or feelings they themselves deem evil. Psychologically speaking, such disowned cognitions and unacceptable affects are symbolized by the idea or image of the devil or Satan. Whatever our religious inclinations, we are all to some extent culturally conditioned to feel that these primitive impulses are "negative," shameful, and antithetical to goodness or spirituality. In extreme cases, over time, these denied impulses strengthen and can no longer be repressed. At that point the psychological defense mechanism called projection kicks in: now the person is shamefully aware of these evil, nasty, profane feelings, but attributes them to the influence of some nefarious external agency such as the CIA, extraterrestrials, demons or the devil. He or she feels driven and controlled by these infernal forces, sometimes being urged by a voice (command hallucination) or compelled, despite moral resistance, by evil entities to carry out uncharacteristic, bizarre or even diabolical behaviors. These are extraordinarily dangerous states of mind.

I suspect Yates felt overwhelmed and resentful about her family responsibilities, but unable to admit it--even to herself. Was that chronic denial a misguided and finally catastrophic effort to be a "good Christian," a good wife, teacher, and mother? This is precisely the problem of what C.G. Jung termed the shadow: those morally ambiguous aspects of ourselves we deem unacceptable or evil, and dissociate. A classic (and highly cautionary) tale of the dangers of denying our shadow is Robert Louis Stevenson's The Strange Case of Dr. Jekyll and Mr. Hyde. Could Yates' repressed shadow--her dissociated Mrs. Hyde-- have been acted out in this heinous crime? Was it the shadow that made her do it? The devil? Demonic possession? Or was it, as mainstream psychiatry dogmatically maintains, aberrant biochemistry that made her mad, post-partum depression, a "broken brain" and raging hormonal imbalance to blame for her evil deeds? How can we make sense of such senseless acts? How much responsibility must we bear for "negative" feelings, thoughts, impulsions, and dealing with them? Could ongoing intensive psychotherapy and closer monitoring have foreseen and possibly prevented this tragedy? Or was this evil inevitable? Complicated questions. You be the jury.

A Wicked Rage for Recognition

Dr. Stephen A. Diamond, Ph.D. — Mon, 21 Apr 2008 21:59:17 -0700

Last Saturday, an eighteen-year-old senior at Chesterfield High School in South Carolina was arrested with ten pounds of explosives and a venom-filled journal containing plans to bomb his school and kill himself. Ryan Schallenberger is described as a quiet but " angry young man," who writes admiringly of the two students that carried out the Columbine massacre. Perhaps not coincidentally, yesterday, April 20, was the ninth anniversary of the mass shootings at Columbine High School. In a chilling trend that was unimaginable at that time, there has been a stunning rash of similar incidents since then, most recently at Northern Illinois University on St. Valentine‘s Day, 2008. Steven Kazmierczak, a supposedly happy, stable, twenty-seven- year-old graduate student in social work, randomly blew away five students and wounded eighteen before offing himself. Why?

Whereas teenagers Eric Harris and Dylan Klebold--who killed a dozen fellow students, one teacher, and wounded 24 at Columbine before shooting themselves--were socially isolated, narcissistic, nihilistic, antisocial rebels, Kazmierczak was said to be a model graduate student with a promising future. But despite the early depictions of a well-adjusted, even-keeled, highly functioning, amiable young man, it turns out that Kazmierczak had a hidden dark side.

Unlike the isolated "loner" profile of so many mass murderers, he was involved in a long-term relationship. But Kazmierczak's relationship was, as we now know, not very stable at all, and he is depicted as having been controlling, verbally and physically abusive, and quite angry. At the same time, others portray him as meek, timid and "mousy." So he seems to have publicly projected a kind of milquetoast persona, beneath which a festering rage secretly rumbled. And it appears Kazmierczak had a history of serious emotional problems following high school, being placed in a residential treatment facility for over a year after becoming "unruly" at home. In addition he allegedly engaged in self-mutilation by "cutting," and had been prescribed psychiatric medications which he resisted taking.

In the months preceding the NIU massacre, Kazmierczak obtained a tattoo of a bizarre, bloody image from the horror movie Saw, indicative of his increasingly dangerous inner demons. Twenty-three-year-old Seung-Hui Cho too, had expressed violent and hostile imagery in his creative writing class at Virginia Tech prior to exploding in April, 2007, shooting 32, wounding 25, and then committing suicide. Harris and Klebold wrote graphically in journals of their diabolical plan. Eric Harris had undergone court-ordered anger management a year before Columbine and was also required to take antidepressant medication, both of which were obviously ineffective.

Cho was another extremely passive, introverted, isolated, depressed, and probably psychotic young man with a significant mental health history from childhood. But barely veiled beneath his almost mute, submissive, sometimes bizarre demeanor and ever-present sunglasses boiled a red-hot rage against people and society. He had been briefly hospitalized, ordered by the court to have counseling, and prescribed Prozac, but appears to have followed through on neither. Kazmierczak also took Prozac to what seemed like good effect, until abruptly discontinuing it several weeks before running amok. But which was the real Kazmierczak: the mild-mannered, affable golden boy on Prozac, or the abusive, controlling, cut-throat killer off it? Did medication serve to sustain his deceptive Dr. Jekyll persona and keep his murderous Mr. Hyde hidden? And if so, at what price? What, if anything, can we learn from all this about evil deeds and dangerous states of mind?

What these tragic cases all share in common is the underlying anger and rage, which cannot effectively be treated merely with medication or anger management. What such profoundly troubled individuals need most is intensive psychotherapy that specifically addresses their rage and its origins, and assists them to constructively redirect it. (I discuss such an approach to therapy in my book Anger, Madness, and the Daimonic. ) Well-known forensic psychiatrist Dr. Michael Welner remarks--after reviewing Cho's "manifesto" (see my previous post on the Unabomber) postmortem--that his rabid videos railing vehemently at society "do not help us understand Cho," but rather "distort him." I couldn't disagree more. What both the hateful videos and his homicidal behavior demonstrate --as in the cases of Columbine and Northern Illinois University--is that there are absolute limits to how much anger or resentment a person can repress before aggressively lashing out against the perceived perpetrators of injury, injustice and rejection. Chronic suppression of anger--the daimonic-- is ultimately futile and dangerous.

What we witness in such extreme cases is the once carefully camouflaged face of frustration, fury, indignation and self-assertion, gone mad. Mental illness is not the primary cause, but rather, at least partly, the psychological consequence. We see the desperate struggle and utter failure of these defeated individuals to constructively claim and defend their fundamental right to be themselves, to creatively find and fulfill their destiny, and our own failure as a society-- and as mental health professionals--to help them productively do so. Instead, they settle for facile infamy.

The Psychology of Psychopharmacology

Dr. Stephen A. Diamond, Ph.D. — Fri, 18 Apr 2008 10:10:40 -0700

After reading psychiatrist Peter Kramer's recent post, "The (modest) Future of Psychopharmacology," I'd like to add a few of my own thoughts on this subject as a practicing clinical and forensic psychologist. Dr. Kramer makes an important point: Psychopharmacology involves far more than simply prescribing pills. Psychiatric medications occupy a predominant place in contemporary psychotherapy. Too predominant, as Kramer himself concedes. Which is why I agree we must take psychopharmacology down from its pedestal, and recognize it as more of an adjunctive than primary treatment modality. Or as he puts it, reduce psychopharmacology to a "constituent of psychotherapy."

As Dr. Kramer indicates, there is a complex, subtle psychology of psychopharmacology. Even for those of us not directly prescribing psychotropic drugs to our patients, the psychological and philosophical implications, ramifications, and consequences of using them (or not) can clearly be seen in the psychotherapy process. To begin with, there are these basic questions: Who is ultimately responsible for our behavior, our choices, our impulses, our selves? Is it us or is it our brain chemistry? Does aberrant neurobiology affect psychology or does aberrant psychology affect neurobiology? Can biochemistry be separated from the self or psyche? I believe Peter Kramer tackles at least this latter topic in his popular book Listening to Prozac.

Many patients reflexively resist taking psychiatric medication because they believe they should be able to manage their lives without it. Needing biochemical support is seen as weakness. Is this simply what Ellis or Beck call a "cognitive distortion" or "irrational belief'? Or what psychoanalysts might term a negativistic "resistance" to treatment? Or flat out denial? Or is it sometimes a healthy, natural reticence? Patients often fear dependence on psychiatric medications. The problem of anxiety is a good example. How do we deal clinically with anxiety? Is all anxiety pathological? How much anxiety must one tolerate before seeking pharmaceutical relief? At what point does "normal," existential anxiety become destructive, debilitating and pathological--as, for example, in panic disorder--necessitating pharmaceutical suppression? Once we do introduce antidepressant and/or anxiolytic drugs to subdue anxiety, where will it end? Will patients become physiologically and/or psychologically dependent on these substances--and, therefore, on those who prescribe them? Might it be more beneficial, for instance, to educate patients about anxiety and its existential inevitability, teaching them to tolerate, move through, and manage it non-pharmacologically whenever possible?

How about anger? Are we too eager to suppress anger with sedating anti-psychotic, mood stabilizing or antidepressant drugs? Anger is a natural human emotion, and, at times, an appropriate and necessary response to life's inescapable challenges and obstacles. Sometimes we need to be angry or outraged, and it is the inability to react angrily, assertively or aggressively when required that is pathological. At what point do we tone down anger pharmaceutically? And at what price? Clearly, when anger or rage become uncontrollable, resulting in destructive behavior, biochemical intervention may be required. But once suppressed, where has the patient's anger gone? Could this pharmacological quelling of anger later result in an even more violent eruption of rage? Has the irritable, resentful or angry patient learned to deal more constructively with frustration and aggression, or merely to depend on drugs to dampen and control such impulses? And what effect does suppressing anger biochemically have on motivation, vitality and creativity?

Pharmacotherapy of psychotic and bipolar disorders is essential and often life-saving. Symptoms can be controlled and stable functioning restored in many cases. But even in these severely devastating and dangerous states of mind stemming, still quite debatably, from a presumed "biochemical imbalance" (see Kramer) or "broken brain," specialized psychotherapy can and must become a central part of treatment. Over-reliance on medication alone is insufficient. In treating such intractable disorders, including addictions, the proper combination of psychopharmacology and psychotherapy can be pivotal in recovery: a delicate balance between encouraging patients to face rather than flee from their demons--anger, anxiety, sadness, loneliness--while not being destructively possessed or overtaken by them.

What of the pervasive use of SSRI's and other drugs to treat depression? Yes, antidepressants do work (see Kramer)--more or less, though not for everyone. They can ameliorate depressive symptoms such as sleep and appetite disturbance, anxiety, avolition, anhedonia or suicidality, and can elevate or stabilize mood. They can provide patients with more energy to deal with their problems. These are invaluable benefits. But antidepressants are not a panacea. Sometimes, as with all medicines, there are unwelcome side-effects. Drugs can't change the patient's stressful circumstances. Nor can neurochemistry exorcise his or her inner demons. Which is why depressed patients also need supportive psychotherapy to help them move forward in life, despite their discouragement, self-doubts, insecurities and fears. When patients instead are perceived and treated as helpless, passive victims of their own biology--whether by psychiatry or other medical doctoring--how does this affect their sense of personal responsibility for bettering themselves and the empowerment to do so? What messages are consciously or unconsciously communicated to patients regarding the nature of psychopathology and psychopharmacology, and what is the psychological impact?

These days, psychiatrists seem to be abandoning the practice of psychotherapy, focusing exclusively instead on psychopharmacology. This is regrettable, since, generally speaking, psychopharmacology is most efficacious when employed in the service of psychotherapy. Yes, taking medication at some point may be a crucial part of the patient's responsibility for getting better; but it is no substitute for real psychotherapy. How psychopharmacology and its implicit psychology is understood and employed in psychotherapy is key: Is medication used merely to deaden metaphorical demons? Or to support confronting and coming to terms with them? When today's primarily biological and cognitive therapies correct course and start asking the right questions (see my previous posting), psychopharmacology can fulfill (as Kramer recommends) its "proper role" as a collaborative, complementary component of psychotherapy rather than its replacement.

Exorcism and the Endangered Future of Psychotherapy

Dr. Stephen A. Diamond, Ph.D. — Thu, 10 Apr 2008 00:09:11 -0700

Exorcism--the ritualistic expulsion of evil spirits inhabiting body, brain or place--has been practiced in some form throughout history, and is probably the prototype of modern psychotherapy. Hippocrates, the father of western medicine, was a trained exorcist. Jesus of Nazareth is reputed to have healed individuals suffering from mental and physical symptoms by casting out demons. Now, more than two millennia later, the Roman Catholic Church is secretly educating a new crop of exorcists to meet a rapidly rising demand for exorcisms in Italy, Australia, America and elsewhere around the globe. Here in the U.S., where there is an acute shortage of formally trained exorcists, burgeoning numbers of suffering souls--some deeply disillusioned with or wary of what mainstream psychology and psychiatry have to offer--are desperately turning to exorcism to expel their debilitating "devils" and "demons."

This widespread explosion of interest in exorcism was confirmed by a Washington Post article (Feb. 10, 2008) titled "Exorcism makes a comeback in Europe: Citing modern ills, hundreds of priests have trained to expel the devil." In that anachronistic news report, a Catholic priest in Poland routinely conducting twenty exorcisms per week explains, " ' there is a group of people who cannot get relief through any other practices and who need peace.' " Another priest who holds a doctorate in theology and serves as the resident exorcist at a psychological counseling center outside Warsaw, states that "the institute realized they needed an exorcist on staff after encountering an increase in people plagued by evil.' " The article notes that, in keeping with current Vatican policy, exorcists regularly consult with psychologists and psychiatrists in an effort to differentiate mental disorders from bona fide demonic possession. But according to one busy practitioner, " 'My remedy is based on spiritual means, which cannot be replaced by any pharmaceutical remedies. . . .I do not stop at the level of just treating symptoms. I'm very much interested in the soul of a person. As a priest, I keep asking questions a doctor will never ask.' "

Perhaps it's time psychologists start asking some of those same questions. What is exorcism? How does it heal? Can we learn something valuable about psychotherapy from exorcism? Are there certain techniques employed by exorcists that psychologists should consider when treating angry, psychotic or violent patients? Are there vital existential or spiritual questions addressed by exorcism--for example, the riddle of evil--that psychotherapy detrimentally neglects?

In one of my previous posts, "Dangerous States of Mind," I alluded to the infamous Andrea Yates filicide case. By the time she deliberately drowned her five children in 2001, Yates was convinced she was possessed. Satan himself, said Yates, compelled her to carry out her evil deed. How can we make sense of her delusions and diabolically destructive behavior? Postpartum depression? Schizophrenia? Bipolar disorder? Or was Yates, as she fervently believed, a hapless victim of "possession"? And if so, what exactly is that? What is evil? Where does it come from? What is our relationship to it? Is it a proper subject of study for psychology and psychiatry? And how can we better deal with it?

The idea of demonic possession is a metaphysical, theological or spiritual explanation for human evil. The Exorcist (1973), based on William Peter Blattey's book about an allegedly true case, provides a highly dramatized depiction of evil, possession and exorcism, and stimulated renewed public fascination with what I call the "possession syndrome" (1996). Psychiatrist M. Scott Peck (1983) draws a distinction (like the Catholic Church, but mistaken in my view) between demonic possession and mental illness. Depth psychologists C.G. Jung (in his concept of the shadow) and Rollo May (1969) provide psychologically sophisticated, secular theories of human evil and daimonic (as opposed to demonic) possession which do not demand literal belief in the devil or demons. (I discuss these matters in detail in my book Anger, Madness, and the Daimonic.)

Possession has been a well-documented phenomenon occurring across cultures in virtually every era. But the term possession is seldom mentioned in the psychiatric and psychological literature. Instead, we speak of obsession, which has similar intrusive, involuntary, egodystonic qualities. Or we refer to "multiple personality disorder" (dissociative identity disorder), in which one or more sub-personalities temporarily take possession of the person against his or her will. Or we diagnose bipolar disorder in those possessed by mania, irritability or melancholy, and intermittent explosive disorder to describe someone repeatedly possessed or overtaken by uncontrollable rage. It must be admitted that the archetypal phenomenon known historically as "possession" persists today in differing forms and varying degrees. The only difference is the way in which we now attempt to explain and treat it.

Phenomenologically, the subjective experience of possession--feeling influenced by some foreign, alien force beyond the ego's control-- is, to some extent, an experiential aspect of most mental disorders. Patients frequently speak of symptoms, unacceptable impulses, thoughts or emotions as ego-alien, and uncharacteristic moods or destructive behaviors as "not being myself," commonly exclaiming "I don't know what got into me," or wondering "What possessed me to do that?" Presently, such disturbing symptoms are hypothesized by psychiatry to be due primarily to some underlying neurological or biochemical aberration. Biochemistry, in the form of the tiny neurotransmitter, has become our postmodern demon du jour for which all manner of evils are blamed.

Most psychotherapy does not adequately treat the possession syndrome. For some bedeviled individuals, the traditional ritual of exorcism or myth of "demonic possession" serve to make more sense of their suffering than the scientific, secular, biochemical explanations and cognitive-behavioral theories proffered these days by mainstream psychiatry and psychology. If psychotherapy as a healing of the soul (not just the mind) is to survive and thrive into the future, our recent overemphasis on cognition, behavior, genetics, neurology and biochemistry must be counterbalanced by the inclusion of the spiritual and depth psychological dimension of human existence.

The truth is, most psychotherapy patients need far more than what pharmaceutical intervention and/or cognitive restructuring--the two most popular "evidence-based" modalities today--can provide. They need and deserve support and accompaniment through their painful, frightening, disorienting, perilous spiritual or existential crises, their "dark night of the soul." They need a psychologically meaningful method to confront their metaphorical devils and demons, their repressed anger or rage, and the reality of evil. They need a secular psychotherapy willing to ask the right questions.

Terrorism, Resentment and the Unabomber

Dr. Stephen A. Diamond, Ph.D. — Tue, 08 Apr 2008 16:15:07 -0700

Last week marked the twelfth anniversary of the arrest of Theodore "Ted" Kaczynski, aka the Unabomber. Kaczynski, as some may recall, was a mad bomber who killed three individuals and wounded twenty-three over a period of almost twenty years in a one-man terrorist attack against society. When I say Kaczynski was "mad," I mean that he was both angry and severely mentally ill. He was, evidently, also a boy genius.

With a purported childhood IQ of 170, Ted Kaczynski entered Harvard University as a brilliant sixteen-year-old undergraduate, going on to earn a Master's and Ph.D. in mathematics at the University of Michigan. He joined the mathematics faculty at U.C. Berkeley in 1967, but abruptly and inexplicably resigned just two years later. From there it was all downhill. He withdrew from the world, building himself a funky cabin in the Montana woods without running water or electricity and subsisted with no means of support other than some money from his family and occasional odd jobs. By 1978, the bombings began.

Most of Kaczynski's victims were academics or businessmen connected to the computer or technology fields. But his homemade pipe bombs also found their way to airline officials, and into the cargo hold of an American Airlines flight in 1979. Fortunately, that powerful bomb fumed but failed to explode. In 1995, after decades of terrorist activity, Kaczynski, now known publicly as the Unabomber, demanded that his "manifesto" be published verbatim--or the bombings would continue. The New York Times decided to print this lengthy, rambling, raging rant against modern technological culture, the style and content of which Kaczynski's brother recognized. On April 3, 1996, the infamous Unabomber was finally arrested, ending his extensive reign of terror.

Several (but not all) of the forensic psychiatrists and psychologists who examined Kaczynski diagnosed him as suffering from paranoid schizophrenia. Renowned forensic psychiatrist Dr. Park Dietz suggested Kaczynski was not psychotic but suffered instead from a schizoid or schizotypal personality disorder. Following a failed attempt to hang himself, he was found competent to stand trial and pled guilty to the charges in a deal with prosecutors to avoid the death penalty. Though his defense attorneys tried to enter a plea of not guilty by reason of insanity, Kaczynski refused, perhaps in part due to denial about his illness, a very common symptom of schizophrenia; or perhaps because of his own narcissism, not wanting to be maligned as mentally ill. He is currently serving a life sentence without possibility of parole in a Colorado prison.

What can we learn from this case about madness and destructive behavior such as terrorism? I suspect that Ted Kaczynski was a frustrated, angry guy, who never fit in to "normal" society. As a graduate student, he sought treatment for symptoms of depression, anxiety, and sexual identity confusion. He had always been described as "aloof," even as a child, felt emotionally abused by his parents, and was cruelly teased by his peers for being different. He is likely an extremely introverted type who never developed the extraverted skills required to live in the world. Kaczynski sounds very much to me like John Nash, the brilliant but tortured mathematician portrayed by Russell Crowe in the film A Beautiful Mind (2001), but with one crucial difference: that person ultimately learned to live with his demons, choosing to manage and even make constructive use of his madness; Kaczynski completely succumbed to his. Like Darth Vader in the Star Wars epic, Kaczynski gave in to evil, the shadowy "dark side." He chose the anonymous but attention-grabbing power of destructiveness over the challenge of living in the world creatively. Kaczynski rejected life rather than embracing it.

Terrorism is itself a form of madness. Perpetrators of terrorism express their rage at the world destructively, in a desperate, last-ditch and sometimes suicidal attempt to gain recognition, fame or glory for themselves and their cause and, ultimately, to give some shred of meaning to their otherwise meaningless lives. Terrorism is typically an infantile and narcissistic act of violence stemming from profound feelings of impotence, frustration, and insignificance. In their own ways, the vengeful shootings at Virginia Tech, Northern Illinois University, and the Omaha mall were, like the mad bombings of Ted Kaczynski, all evil acts of terrorism. Terrorists try to force the world to meet their own narcissistic demands, and, when this doesn't happen, they lash out violently. Terrorism is a failure to find a creative solution to life, to find and fulfill one's true destiny. Terrorism is, in most cases, the madness of resentment.

Dangerous States of Mind

Dr. Stephen A. Diamond, Ph.D. — Fri, 04 Apr 2008 14:06:50 -0700

Last Saturday night, forty-one-year-old Mark Castillo drowned his three children, ages 2, 4 and 6, in the bathtub of a Baltimore hotel room. He and his estranged wife, pediatrician Amy Castillo, were reportedly engaged in a bitter and protracted child custody battle, a sadly not uncommon occurrence. After deliberately drowning each of his kids during his unsupervised visitation with them, Castillo, according to reporters, superficially stabbed himself in the neck several times with a steak knife and swallowed approximately one-hundred Motrin in a half-hearted suicide attempt. He awoke the following day and informed the hotel staff what had happened, allegedly telling paramedics at the scene, "I know what I did was bad. I did it. I drowned them." Incredulous neighbors and acquaintances of the Castillos are quoted as describing him as a very polite, nice person, a "wonderful father" who "loved his children."

According to numerous news sources, Mr. Castillo had been diagnosed two years ago as suffering from a mood disorder, possibly bipolar disorder, as well as narcissistic personality disorder. He made at least one prior suicide attempt, became itinerant, residing in his car, was involuntarily psychiatrically hospitalized, and threatened to hurt his wife by killing their children. In 2006, the year he and his wife of eight years separated, he had allegedly gone so far at one point as to purchase ant poison, duct tape, and a utility knife for some suicidal and/or homicidal plan. Castillo had evidently been in psychotherapy of some sort in 2007, leading two therapists to opine that he posed a low risk of dangerousness to his wife and children. Amy Castillo obtained a restraining order against her husband in 2006 to protect her and the kids, but it was discontinued in January 2007 due to a perceived lack of supporting evidence of abuse or dangerousness.

U.S. Department of Justice statistics indicate that between 1976 and 1997, nearly 11,000 children were murdered by parents or step-parents in this country. Just days earlier, in an upper-middle-class Louisville, Kentucky suburb, a thirty-seven-year-old widowed university student was charged with killing her two children, a boy and a girl, ages 10 and 14. They had, according to police, been shot to death in their beds while fast asleep. According to interviews, the woman was described by neighbors as a "good mother." Readers may remember the high-profile cases of Susan Smith and Andrea Yates. Why would any parent murder his or her own offspring? Motivations vary, from self-interest, to spite, to madness.

Drawing on my experience as a forensic psychologist, this tragic case of paternal filicide (the killing of one's own children) raises several potential issues: First, what is the defendant's current mental state? Is he capable of comprehending the nature of the charges and proceedings against him? Can he cooperate rationally with his defense counsel? Or is he so severely mentally ill that he is not competent to stand trial at this time. If he is competent to stand trial, the next question has to do with his mental state at the time of the murders. Was he psychotic or manic or profoundly depressed? Was he able to appreciate the nature and quality of his actions? Could he differentiate between right and wrong? Did he know that what he was doing was illegal, immoral and evil? If not, he could, depending on Maryland law, possibly be found (like Andrea Yates, who similarly drowned her five children in Texas) not guilty by reason of insanity (NGRI) and confined indefinitely to a psychiatric hospital rather than prison.

Whether he and his attorney will decide to invoke this difficult-to-win-defense (fewer than one-in-four insanity defenses succeed) remains to be seen, especially in light of his alleged incriminating confession to paramedics the day after the drownings, in which he supposedly said "I know what I did was bad." This seems to indicate consciousness of guilt and an awareness of the evil or immoral nature of his act. But it could conceivably be legally argued that this awareness was only post-episodic, being stated more than eighteen hours after the incident occurred, and, therefore, not necessarily an accurate reflection of his state of mind at the exact time of the offense.

Judging by news stories and what we know of similarly contentious child custody cases, Mr. Castillo may be an extremely self-centered, angry and controlling individual who was ultimately unable to psychologically cope with the disintegration of his marriage and family (his divorce had been recently finalized). Narcissistic personality disorder, one of his supposed diagnoses, is defined by the DSM-IV-TR as "a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. . . " and commonly includes a sense of entitlement, interpersonal exploitation, and lack of empathy for others. For the narcissist, it's all about me, my needs, what I want. Such pathological narcissism, grandiosity or excessive selfishness is evident from early adulthood, and can be seen as a pervasive characterological defense against deep feelings of inferiority, helplessness, sadness, and unlovability stemming from certain infantile and childhood needs having not been adequately met. When this inflated persona is inevitably deflated by stressful life events such as divorce, rejection, abandonment, failure and loss, narcissistic rage is triggered, along with other long-buried emotions. The desire for revenge, retaliation, and the compulsive need to repay the hurt no matter what it takes is characteristic of narcissistic rage. These overwhelming emotional reactions are sometimes so severe as to engender or exacerbate what we diagnostically define as a major depressive episode, mania or even psychosis, causing significant impairment of perception, rationality, judgment and impulse control. In such debilitating, disorienting and dangerous states of mind, anything can happen.

Could this horrific crime have been prevented? Perhaps. While violent behavior is far from predictable by psychologists, the alarming history of circumstances, signs, symptoms, and behaviors preceding the murders certainly would cause most seasoned clinicians serious concern. Should he have had unsupervised visitation? Pseudoinnocence--the inability or refusal to recognize and anticipate the potentiality for evil deeds--is dangerous, especially in mental health professionals. And psychotherapists need to focus specifically on more effectively dealing with anger and rage in treatment. But hindsight is always 20-20. The fundamental philosophical and legal question now is whether a person who commits such an evil act as this--even if proven to have been in the grips of tumultuous emotional turmoil --should be held accountable by society for his or her bad behavior. That may be for a jury to decide.