How can you responsibly and reliably make anthropological generalizations from this one place? Why should anybody else in any other part of the world be interested in your little patch—why is it anything more than a few humps and bumps?
—Matthew Johnson, Ideas of Landscape
There are some obvious methodological problems for these interviews. First, how far can the answers given to the questions be accepted as truthful? Second, if my interpretations of what the interviewees said are right, how far is the psychology described special to people with their diagnosis? Third, if my descriptions do succeed in capturing something distinctive about this group of people, are there really any more general lessons to draw about psychiatric interpretation?
(There is also a fourth, very deep, question: What is the appropriate attitude to have toward this group of people? Their tragic lives evoke sympathy in an interviewer. But also they have done appalling things to other people who are not present to win sympathy. Is there an emotional balance between the harshness of ignoring the sadness of the patients’ own ruined lives and a sentimental sympathy that blanks out what they did to others? These issues will be put aside here until Chapter 25, “Character, Personality Disorder, and Responsibility.”)
Central to the Cleckley account of the psychopath is the picture of someone conning and manipulative. This reputation extends to those in the broader category of antisocial personality disorder. So there is an obvious methodological problem: Can things said in the interviews be trusted?
Normally a decision about whether to trust what someone says draws on two sources. There is an intuitive “reading” of the person, based on such clues as eye contact, demeanor, tone of voice, and choice of words. And there may be independent evidence, either about what is said or about the person’s trustworthiness.
In these interviews an intuitive reading was not always easy. Regarding some of the interviewees, I felt that their cold, impersonal responses gave no clue about their trustworthiness. (Unless this kind of response is itself a sign of their untrustworthiness, but that does not seem obvious.) Occasionally the voice of the therapist seemed audible. Sitting opposite a very tough-looking man, it can be disconcerting to hear him talk about now being more in touch with his emotions.
For the most part I did get intuitive impressions. But first there was a barrier to break through. Arriving at Broadmoor, I get a large bunch of keys—to the locked perimeter gate and to the locked doors on the way to the wards. Arriving at the ward, I go to the nurse. He calls the patient and takes us both to the interview room. So I appear, like a jailer with a jangling bunch of keys at my belt, in the company of someone probably seen as an authority figure. Compared to many of the people I interview, the way I talk may reflect differences of social class and education. It may remind them of past encounters with schoolteachers, lawyers, or judges.
I try to break down the barrier, but it takes time. Before leaving, the nurse may have said briskly, “Robinson, you have got a research interview. Get into the interview room.” When we have sat down together, I say, “My name is Jonathan Glover. I am happy to be called Jonathan. Would you like me to call you Mr. Robinson or Frederick?” Usually the reply is along the lines of “Fred will do.” The interviewee has seen a brief account of the project and has consented to the interview. But I spell out that I have not come to ask about his criminal offense. I have come to ask about how he thinks about some questions about right and wrong, and that he does not have to answer anything he does not want to. But so far little has been done to reduce the height of the barrier.
Usually the atmosphere gets better during the hour or so of the interview. I ask questions in a way I hope is both friendly and respectful. To some extent the interviewees seem to warm to being asked about how they think and how they see things. With luck, it may come across that I really do find what they say very interesting.
I put my tape recorder on the table between us and switch it on. Because I am inept with such things, after a minute or two I say, “Let’s just check if this thing is working.” Sometimes I find that nothing has been taped and then fiddle with the recorder rather incompetently. The man opposite looks at me with increasing incredulity and then says something like, “No, no, not like that. Here let me do it,” and then arranges it as it should be. This is not something I could (or would want to) set up deliberately, but its happening helps things along.
As the barrier breaks down a bit, I start to get some intuitive impression of the person. Occasionally I think I hear a false note in what is said. When this happens, it is usually linked to a sense that the person speaking believes, wrongly, that making a good impression on me may help his progress toward release. (If he does believe this, it is despite explanations that I am not attached to the Broadmoor staff.)
For the most part the interviewees’ eye contact, facial expressions, and tone of voice suggest genuineness. It is quite hard to get a few of them to speak at any length. They seem very inarticulate, or else disconcerted by the novelty or apparent oddity of the questions. Or there is the possibility that their fluency of speech may have atrophied in their years of confinement. None of this seems like a deceptive pose. But these are a minority. Most of the others come to seem quite pleased to be asked these personal questions about their values and their point of view, and to like being listened to. They often override what I have said about the interview not being about their criminal offense. Sometimes they seem eager to discuss it, as if there is something they are keen to express. And often, without being asked, they pour out things about their childhood. With all this, what sometimes comes across is a driven quality in what they say. It seems emotionally charged rather than calculated.
Of course, the brilliantly deceptive Cleckley psychopath might come over like this. There is a danger of being too influenced by the Cleckley picture of the manipulative con-man. This may make it impossible for anything ever to count as evidence against it. Signs normally suggesting a liar are taken to confirm the dishonesty. But signs normally suggesting honesty are taken to confirm the brilliantly manipulative acting. At various points in this book similar questions will be raised about the framing effects of other diagnostic categories. There is a general problem in psychiatry that traditional diagnoses can exclude in advance interpretations that count against their validity. The abstract checklist can obliterate the psychological complexity apparent when people are listened to with fewer preconceptions.
If the Cleckley picture is to be vulnerable to possible evidence against it, there has to be the possibility of an interpretation that sometimes takes signals suggesting genuineness at face value. We all face the problem of other minds all the time. We all “read” each other, and we never know with absolute certainty that any particular reading is correct. But a lot of the time we have fairly good reason for our interpretations, despite the fact that we sometimes disagree about when this is so.
With the people I interviewed, there is sometimes independent evidence. One obvious Cleckley-type thought is about the accounts they gave of their desperate childhoods. Making up stories of this kind could be an obvious ploy to gain sympathy and to excuse themselves from responsibility for the terrible crimes they have committed. But psychiatrists working in Broadmoor—not a group many would suspect of lying to improve their patients’ reputation—have said in conversation that the huge majority of their patients, 80 percent or more, have had such childhoods.
For much of what the interviewees say there is no available check using independent evidence. Intuitively, the things said seemed mostly—but not always—genuine. Such interpretations are to some degree subjective, and those reading the answers quoted sometimes may prefer their own interpretations over those suggested here.
In interviewing these men I was trying to glimpse the parts of their inner lives that have to do with their values, morality, and conscience. Even if the picture I present here is roughly right, how different are these men’s inner lives from those of many other people? I have suggested that their inner lives include a command morality, ideas of primitive fairness, anger, shallowness of moral thinking, a shallow conception of themselves, a tendency to put on blinkers, and the building of a defensive wall against being hurt or humiliated by other people. But each of these characteristics is found in many people who have no psychiatric diagnosis. What are the implications of this for the usefulness of the account that emerges from the interviews? And what are the implications for the usefulness of the category of antisocial personality disorder?
Take one of the apparent features of their inner lives. One of them said, “You build up this defensive wall.” But is this really a distinctive response of this group of people? The poet Ted Hughes wrote something in a letter to his son Nicholas that may find an echo in many people. He mentioned a sense of inadequacy people have, the sense of not having a strong enough ego to cope with inner storms. He linked this to the vulnerable child still inside each of us:
Everybody tries to protect this vulnerable two three four five six seven eight year old inside, and to acquire skills and aptitudes for dealing with the situations that threaten to overwhelm it. So everybody develops a whole armour of secondary self, the artificially constructed being that deals with the outer world, and the crush of circumstances. And when we meet people this is what we usually meet … That’s how it is in almost everybody. And that little creature is sitting there, behind the armour, peering through the slits … Every single person is vulnerable to unexpected defeat in this innermost emotional self. At any moment, behind the most efficient seeming adult exterior, the whole world of the person’s childhood is being carefully held like a glass of water bulging above the brim.1
Of course, the testimony of Ted Hughes does not guarantee that everybody develops a defensive wall—“a whole armour of secondary self ”—but if many of us respond to his thought with some recognition, this suggests that the defensive wall may be protecting far more people than have the diagnosis of antisocial personality disorder. To find out how many other people, and to find whether the wall is more common or is stronger in those with the diagnosis, needs subtle empirical investigation, including a follow-up study using a control group of violent criminals without the diagnosis.
Even in such a controlled study there would still be difficult issues of interpretation. If the defensive wall is invisible, how strongly does this suggest it does not exist? Or how strongly does it suggest the skill with which the wall itself can be defensively concealed?
The question of whether the psychology described here is characteristic of antisocial personality disorder raises an alternative. There may be advantages in moving away from seeing a diagnosis as a separate box that someone either does or does not fit into. The main alternative is to see people with psychiatric disorders in terms of their positions on various psychological dimensions.
The strong tradition of psychiatric boxes is influenced by seeing conditions such as bipolar disorder or antisocial personality disorder as being all-or-none: something like mumps, which a person either does or does not have. Those with these diagnoses inhabit separate boxes, largely cut off from variations found in “normal” people. Many psychologists hold the alternative view that there are “dimensions of personality”—that each of us can be placed somewhere on a continuum between, for instance, emotional stability and manic depression. On that view there is some arbitrariness in the cutoff point for psychiatric disorder.
This account of the contrast sharpens it by some simplification: we have left out the qualifications that bring the two approaches closer to each other. Not all “standard” medical disorders are so all-or-none. And on a continuum some groups may cluster at the extremes. But there are real differences of emphasis. Supporters of the continuum view may accuse the others of making psychiatric patients more alien than they should be. Supporters of the all-or-none view may say the continuum approach downplays the distinctiveness of psychiatric disorders. As in other parts of medicine, each approach may fit some disorders better than others.
Questions about antisocial personality disorder remain. Is it a useful category? If so, is it “separate” or is it at the extreme of various continuums? The defensive wall is just one of the features that may be distinctive. If Ted Hughes was right, individuals with this diagnosis are far from unique in having the defensive wall. But they might still build the wall more often, or build a higher and more fortified one.
These unknowns leave the category of antisocial personality disorder up in the air. Some psychological clusters seem particularly common among the interviewees. If this is true of most people with the diagnosis, the category may have substance. But I also came away with the impression that the diagnosis, with all its Cleckley associations, gets in the way of talking to these men, of hearing what they say, and of seeing them as the people they are.