Tuesday, May 8, 2012

Conversations with a Psychopath

There are a few different types of people that I run across in my unit. Usually they're 1) lying 2) super crazy or 3) lying and crazy. Lately though, there's been a guy who I'm about 99% sure is a true psychopath. True psychopaths are rare, and they generally don't end up in a crisis bed unit. He's sort of defaulted to my regular caseload and it is so. freaking. cool. Seriously, it's so fun and so clinically interesting. The thing with psychopaths is that therapy is contraindicated, because it's been found to only make them better psychopaths. So I don't even have to put my shrink hat on. Our "therapy" literally consists of me letting him talk and studying what he's doing. 

This guy is creepy and makes the hair on the back of your neck stand up. This guy talks about the murder he committed as "something that had to be done." One day, after talking with him, I walked away and had the clearest thought of what it must feel like to be prey. I've never felt so studied. This guy would eat your brains just to see what they tasted like. 

The key aspect of psychopaths is that they have no true understanding of empathy. They are singularly focused on attaining their goal through whatever means necessary, and it never occurs to them to consider how they may influence other people. They are also fairly emotionless. The best description I've ever heard is that angry criminals are like pitbulls, while psychopaths are like snakes. Pitbulls get angry and react. Snakes plan and execute. 

One day, as this guy was talking very logically and rationally about his plan to kill himself, I asked about his family. And for a brief second he faltered. So fascinating. But even better is how he recovered. This guy stops for a second, clears his facial expression, leans down, and softly says, "You know, I really respect women. Some of the brightest, most intuitive doctors I've worked with have been women. I just want you to know that I never underestimate the intelligence of a woman." In my head I'm thinking, "Do the lambs still scream, Clarice?"

I freaking love this stuff. 


  1. I freakin' love this post! Keep them coming! Reminds me why I ever went into psychology and makes me totally miss it. My most favorite place I ever worked was a 51/50 hospital. Love the crazies. And a true psychopath WOW.

  2. ...and THIS is why I have nightmares....

  3. Awesome. I still get the creeps when I think of the guy I tested with Claudi using the PCL...I had the same hair-on-my-neck thing going on, and she couldn't WAIT for me to be done with the testing. But in the same way you described, it was totally a thrill and one of the reasons that I love psychology. I miss prisons. College students don't present these opportunities very often... :) Lucky you! Be careful!

  4. And this is why I work in a prison, too! Glad to know I'm not the only one intrigued and freaking love dealing with these guys!