Few laypeople realize how little we actually know about the underpinnings of psychiatric disorders, writes Daniel Carlat, MD, in Unhinged: The Trouble with Psychiatry—A Doctor's Revelations about a Profession in Crisis.2 Carlat, who trained at Harvard Medical School and is currently on the faculty of Tufts University, has been a practicing psychiatrist for fifteen years.

He notes: “In virtually all of the psychiatric disorders—including depression, schizophrenia, bipolar disorder, and anxiety disorders—the shadow of our ignorance overwhelms the few dim lights of our knowledge.”³

We do know that certain neurological conditions carry with them a propensity for deceit. Psychopaths, for example, have a glib ability to lie that is somehow part and parcel of their strangely different neurological makeup.4 (Psychopaths seem to have notable deficits in the right side of the brain—the side that allows for empathy.)⁵ Those with borderline personality disorder share this deceitfulness and also have an uncanny ability to manipulate.⁶ This latter disorder is known to be a disorder of “attachment”—that is, a failure to form an effective connection with caregivers in early childhood.⁷ Borderline personality disorder, too, is thought to be a disorder of the empathetic right hemisphere.⁸

The problem with antisocial and borderline syndromes is that embedded within the dysfunction is the conviction that “nothing's wrong with me—it's everyone else who's crazy!” This belief, especially when held by those who show more extreme traits of narcissism, makes it difficult to be open to psychological help. Even if forcibly placed in front of a psychiatrist—in a prison setting, for example—people with these disorders will naturally dissemble, projecting their own faults onto everyone but themselves.

Carole, for example, still insists that when someone is outright abusive in how he treats her—for example, even if he rapes her in a drunken stupor—her first instinct is always to attempt to help that person. She gets closer so as to assist him; if she doesn't, she feels great guilt. In many of her other observations, Carole often alludes to her sense that her problem has always been that she's just too nice. However, many who know Carole well are extraordinarily fearful of her, citing her propensity for publicly smearing those who offend her, her tendency to involve the police or child services in any matter that doesn't go her way, her vitriolic temper when crossed, and of course, her ability to turn her children against others.

In Carole's case, people often found that what she said at any given time seemed to make sense. It was only later, after reflection, that a person might realize something was odd—things didn't add up. For example, Richard Senft, Carole's first husband, explained that it wasn't until the marriage broke up that he realized the extent to which he'd been lied to and manipulated. “It may be that her radar for prospective long-term mates guided her not just to men who were basically decent but also to men who were particularly obtuse about pathological behavior, men who just couldn't imagine it and thus had no defenses against it,” notes Joe Carroll, Curators' Professor of English at the University of Missouri, St. Louis.9 “They were like the birds on remote islands, never before visited by humans, who could be knocked over by hand, since they had no instinctive fear of sailors out for an easy meal.”¹⁰

In their classic book on borderline personality disorder, Stop Walking on Eggshells, Randi Kreger and Paul Mason describe a similar reaction—it is the “light bulb effect,” when deceit and manipulation finally make sense because they are suddenly seen as purposeful activity propelled by an underlying personality disorder.¹¹ But Carole may well have not been alone in her misbehavior. Marty Sessions's addictions had caused problems in all of his marriages, even though Susie Sessions had clearly found in him the love of her life. Carole Alden and Marty Sessions may well have one-upped each other in their interactions—each feeling justified for the pain inflicted by virtue of the previous pain inflicted by the other.

In any case, one person who has suffered from decades of Carole's manipulations says: “It's not like Carole gets up one morning and says to herself, ‘I need $100, so I'm going to go con some kindhearted Mormon.’ It's much more complex than that. Carole's got a very rational intelligence that rides hand-in-hand with a deeply emotional irrationality. Unfortunately, the rational part of her brain is subservient to the nutty part. The nutty part makes a decision, and then the rational part says, ‘How can I make this happen?’”

Carole's claim that Marty had pierced her genitals took her case to a new, lurid level—as evinced by the “Wife Kills ‘Depraved’ Hubby Who Made Her Wear Chastity Belt” National Enquirer headline.¹² Carole's theatrics—lowering her head to the defense table and sobbing in the courtroom at mention of Marty's intentions involving a chastity belt—took the tale even further over the top.13

Although Carole said she'd soft-pedaled her accusations against Marty in the days immediately following his death, the stories she ultimately told diverged from known facts and also would have required superhuman abilities on her part. For example, Carole had pointed out to Deputy Josie Greathouse a total of four genital piercings, two on each side of her labia. At that time, Carole had said that Marty had intended to put a chastity belt through the holes, but he had never done so. In a later retelling of the story, however, she claimed to have twelve piercings (six on each side of her labia), all slowly done by Marty over a period of six hours, with her passing out multiple times from the pain and Marty shocking her back awake with alligator clips attached to her sensitive parts.¹⁴ She was then sewn completely shut for weeks, almost dying of septicemia.

Such confabulation is typically seen in personality-disordered individuals—most prominently, those with antisocial and borderline personality disorders.15 Whether sadomasochists show higher rates of personality disorders is hotly debated—a vocal group protests inclusion of such atypical sexual behavior in the psychologists' catalog of mental disorders (the DSM), saying that it discriminates against those who practice alternative sexual lifestyles.¹⁶ (Despite or because of its clear association with forensic populations, the study of those who practice sadomasochism has long been hampered by advocacy groups who seek to destigmatize the practices.)

But is it instead, as one study perceptively asks, that those who “misbehave” sexually are simply generally misbehaving people whose misbehavior also shows up in the sexual domain?¹⁷ There is little question that among prison populations, sexual sadism and related behaviors are found in far higher percentages than in the normal population. But the jury is still out. In any case, although nobody's quite been able to deduce a “distinct neurobiological substrate or correlate of sexual deviancy,” quirky brain function is definitely affiliated with a higher incidence of deviant sexual behaviors.¹⁸ Clearly neurotransmitters and sex hormones will play an important role in clarifying our understanding of sadomasochistic tendencies.¹⁹ (A 2006 study came to the surprising conclusion that power—not the giving and receiving of pain—lies at the core of sadomasochism.)²⁰

In regard to Carole's sadomasochistic tendencies, there was another bombshell in the case—one that never exploded. A local man eventually admitted that Carole had proudly showed him her genital piercings, and a second local man was also thought to have seen similar behavior. This exhibitionism, far from the sobbing, ashamed demeanor that Carole showed in court, demonstrated that Carole was hardly the unwilling victim she made herself out to be and also provided clues as to her manipulative side. If prosecutors had learned of this development, they could have used this knowledge to devastate a key element of Carole's defense.

But prosecutors remained unaware of this fact.

So how does this all relate to Carole Alden's seemingly formative crisis—her possible molestation by her father?

Carole's old confidante, Penny Packer, would later say: “Carole never said anything about her father molesting her when I knew her, when she was in junior high school. And I think she would have told me. She didn't mention anything about it until she was a full adult. She never came out and said in black and white what he did—it was always left up to the conjecture of the person she was telling. She'd use subtle innuendo to insinuate he'd been sexually abusive, but she'd never come right out and say. Same as at the massage parlor. I've known Carole's parents and friends. I just can't see it happening.”21

One person who knew Carole well when she was in her late teens and early twenties said she made vague accusations of abuse about her father even then, never supplying any details. At first Carole was believable, he said, but gradually, during the course of getting to know the Alden family, he began to doubt her story.

It is important to note, however, that sexual abuse during childhood may lead to borderline personality disorder—“the more severe the abuse was, the more repeatedly it occurred, the closer the person was to the victim, and the more they were threatened to be ‘silent,’ the sicker they are,” writes Blaise Aguirre, a psychiatrist who specializes in understanding borderline personality disorder in adolescents.²² But on the other side of the equation, those with borderline personality disorder commonly make false allegations of abuse. Emotional needs—and the resulting revenge when such needs are not being met—are common motives in such cases. Forensic psychiatrist Richard Hall notes that such false allegations “occur with some regularity,” particularly from those with substantial traits of borderline personality disorder.²³ Hall urges investigators to consider whether the accuser exhibits a pattern of making other false accusations; if such a pattern is present, the allegation is more difficult to take seriously. The mix of victims and those only crying wolf can make it very hard to respond sensitively and accurately in this realm.

Randi Kreger, author of The Essential Family Guide to Borderline Personality Disorder, cautions, however, that the behavior of those with borderline personality disorder varies so much that generalizations should be avoided. Kreger notes that the word abuse is vague, and that those with borderline personality disorder may be “splitting and seeing their childhood and parents as all bad.”24 While those with borderline personality disorder do outright lie, their “mental and emotional disturbances can also give them firm beliefs about things that may not really be true.”²⁵

When false allegations are made against virtually all available evidence, we swing back again to ideas related to left-hemisphere dominance—the resolute insistence in one's own version of a story, facts be damned.

Carole began sharing her vague insinuations about her father with family members when she was in her late twenties and thirties—often at times when she was at her angriest and most vengeful. Recollections of her subtle innuendos still leave a sense of frustration among the other Aldens. How do you talk with someone who makes such an insinuation, however faint, and then refuses to speak further about it—shrugs it away with a “just kidding” sort of air?

Both Carole's parents remained close to their other children, none of whom showed Carole's over-the-top teenage angst. Her parents couldn't help but hope that once Carole passed into her twenties, she would level off and become like her siblings. But Carole's antagonism for her father simply intensified, sometimes reaching irrational levels.

For example, not long after Carole's first marriage, women with babies who could not tolerate cow's milk would sometimes stop by to see if they could obtain milk from Carole's little goat herd, which was clearly visible from the highway. But rather than discuss whether goat's milk was available, Carole would sometimes take the opportunity to inappropriately change the topic of conversation to describe to these strangers what a jerk her father was.

This type of irrational “splitting” behavior is yet another aspect of borderline personality disorder. With splitting, another person is seen as either all good or all bad, with nothing in between. In the case of her father, Carole frequently painted him as all bad. Indeed, this type of black-and-white thinking pervaded many of her interactions. Carole's husbands and lovers were all good, at least until they disapproved of some aspect of Carole's behavior—at which point they became all bad.

By the time of Carole's marriage to Marty, her relationship with her father had settled into an uneasy truce. Their conversations were kept to a minimum—if Carole called home and her father picked up, for example, he'd say hello and then pass the phone immediately to her mother. At the time of Marty's homicide, her father was recovering from a bout of cancer, which had arrived like an anvil falling from the sky onto this virile, healthy outdoorsman.

Marty's killing upset the silent truce between father and daughter. They began to have heated phone conversations—the substance of the conversation apparently surrounding Carole's intention to tell the court that she had been molested as a child. Carole's father was devastated. Within two months he was dead—not of cancer, but of a stroke. Within three days of his death, Carole had created an intricate fabric rainbow trout in his honor.

And she charged ahead with her plans to accuse her father. Carole's mother, weighed down with grief at the loss of her husband of forty-eight years, was blindsided. She could see no reason for Carole to go on with her accusations. Her father could not defend himself—what would be the point? Carole replied to the effect that the judge might be more favorable to her if these accusations were made. She never explained exactly what her accusations were or what she was going to say, but she vowed her charges were true. Later Carole would vilify her family for their lack of support, telling others that her family had actually denied to investigators that anything had happened. Of course, from her family's perspective, there was good reason for the denial.

One investigator who has heard the tapes of Carole's external phone messages simply shakes his head. “To listen to all those phone calls and to hear how everything was always someone else's fault…. She always made everything all about her, her loss.” Another officer says: “I was stunned. Just stunned. In the first phone call Carole had with her family after her father's death, there was not one word about her father, or a single question about how the family was holding up. It was always me, me, me. That was the way all her phone calls were. Her plight. Her future. Nothing else mattered to her. The inhumanity of it wouldn't go out of me for days.”

Square at the crossing of the most pernicious of personality disorders—borderline and antisocial—lies narcissism, that most insidious and least understood of traits.

LEAPFROGGING LOGIC

At the National Institutes of Health, Carolyn Zahn-Waxler has spent decades researching questions that focus on environmental factors and characteristics of children that lead to anxiety, depression, and aggression. She has worked to understand characteristics such as a difficult temperament or personality, impulsivity, and negative emotionality; she has also studied the effect of emotional factors such as harsh discipline and parental rejection. She conducts longitudinal research, following families over time. This makes it possible to learn how a child's inborn personality traits interweave with parental treatment to influence how problems develop. To do this, she compares children from high-risk environments (for example, children with depressed mothers) to those in low-risk environments (children whose mothers are psychologically healthy). She has a good understanding of the methodology necessary to gain a scientifically grounded perspective. Her experience could prove useful in establishing more solid science to help us understand the environmental factors and characteristics of people that eventually lead to domestic violence.

The best way to truly sort out the problem of understanding battered women, Carolyn Zahn-Waxler suggests, would involve constructing a long-term study of women who vary in risk for being battered.26 (Technically, this would be known as a “longitudinal pre-post design” study.) Researchers would assess the preexisting characteristics of the women in the study, including any penchant for deception or violence as well as their personality traits and problems. It would also include similar assessments of their partners. These assessments would be done both before and after the battering or family violence situation. In theory, this method would allow everyone to gain a clear understanding of battered women. Unfortunately, such an exercise could be done only as a thought experiment. Unlike in Zahn-Waxler's research with children, the women and men who would be involved in this study would already have had such diverse life experiences that it would be impossible to obtain adequate measures of what the women (and men) were like prior to their relationship with a violent partner.

What researchers could do instead, Zahn-Waxler observes, is an in-depth study of women who have been battered to examine the ways in which they compare and differ from one another. This should be done in conjunction with a comparison group whose members have never experienced battering. (There are also battered men, so genders could be reversed in this discussion.)

Once an in-depth study was done, the women could be sorted into different groups depending on their circumstances and psychological functioning. These classifications would not be based solely on self-reports but would include direct observations and assessments by others who know the women—both clinicians and family members. Poring over the results, researchers could then make a reasoned estimate of the proportion of women prone to victimization as a consequence of the qualities they themselves brought into the situation. This would be the golden stage—the time when an in-depth understanding of the full range of battered women could be developed. What accounts for who puts themselves in this situation and who doesn't? What is the difference between women who experience violence but do not strike back with violence and women who do?

As Lenore Walker has implied, some of these women would be normal people who simply made an unlucky choice. Others would not initially have seen problematic traits in their partners because of qualities they themselves valued that also helped them meet their own needs. (They might, for example, have been attracted to a person who is dominant, assertive, and liked to be in charge. These positivesounding traits can become aversive as a couple gets to know each other better and the violent partner becomes more domineering and controlling.) There are probably important variations within this latter group, which might include women who are normal but who are not good at reading others' emotions, as well as women who are immature; those who don't want to see what is clear to others; and those with mild personality problems.

Then there would be a group whose members are victim-prone because of preexisting personality problems that encourage violent partners to engage in aggression. Among this group would be women who would trigger abuse via their own antisocial behavior toward their partner. There may be women who actually make things up to explain their own violence. We might not like to admit that such women (or men) could exist, because it could stigmatize the many innocent women who unwittingly find themselves in a battering situation. But to truly comprehend battering in an objective manner, it's important to understand the people involved in situations where battering is claimed. As Linda Mills points out in her masterful Violent Partners: “The popular conception of domestic violence, in which the female victim lives in terror of her controlling abuser, only represents a small fraction of the American couples struggling with violence today.”27

The supreme importance of all of this research is in how it could help women understand their own inclinations, as well as those of their partner, and thus help alert them to danger before they get into an abusive situation. Moreover, it could help women see that they don't have to repeat bad choices once they have been in one of these relationships. Far from being research that “blamed the victim,” it would instead be helping women to avoid becoming a victim in the first place. No longer viewed as hapless victims, women could ask themselves those vital questions: “What parts do you have control over? What can you become more aware of so as not to choose, or continue to participate in, this?”

As it stands now, battered woman syndrome has leapfrogged its lack of scientific underpinnings and is ensconced in laws in most states, including Utah, where it may be used as a defense in court cases in which women have assaulted or murdered male partners. Use of this defense implies that the defendant is a “normal” woman whose problems were created solely by her violent male partner—the defense says it is these partner-induced problems that led the woman to injure or kill her partner in self-defense. But in all probability, many situations are far more complicated or nuanced than that simple defense implies. In fact, not only might Carole and Marty's situation be full of shades of gray, but it may well be that Carole Alden's preexisting personality traits played a role in her killing her husband.28

David Faigman, John F. Digardi Distinguished Professor of Law and director of the University of California Hastings Consortium on Law, Science, and Health Policy, could have been describing the Carole Alden case when he summarized the situation with battered woman syndrome:

The amount of research that actually exists to back the claims of expert witnesses who testify on the battered woman syndrome makes cold fusion look as solid as the second law of thermodynamics…. At the start … the hypothesis had little more support than the clinical impressions of a single researcher. Five years later, Walker published a second book that promised a more thorough investigation of the hypothesis.²⁹ In fact, however, this book was little more than a patchwork of pseudoscientific methods employed to confirm a hypothesis that the researchers never seriously doubted.³⁰ Indeed, the 1984 book would provide an excellent case study for psychology graduate students on how not to do empirical research. Yet, either because they shared the researchers' political agenda or did not look at or understand the science, judges welcomed the battered woman syndrome into their courts. Increasingly, however, legal commentators are realizing that this original conception was without empirical foundation and, perhaps more troubling, inimical to the political ideology originally supporting it. In short, in the law's effort to use science to make good policy, it is now obvious that the battered woman syndrome provides neither good science nor good policy….

[B]ecause the syndrome has no empirical basis and thus might apply in any case, many defendants claim it when the facts of their cases fall well outside any reasonable conception of self-defense. For example, Lenore Walker sought to testify when a defendant hired a hit man for $10,000 to kill her husband. These abuses cast long shadows and undermine the effort to make the law more responsive to the true challenges of domestic violence.31

Faigman wrote those words in 1999, but as Linda Mills notes in the introduction to Violent Partners, as the decade has passed, the situation hasn't changed.

In 2008, if a woman is hit by her husband and calls 911, the police arrive promptly and take the incident seriously. The officer doesn't suggest that his time is being wasted, and he doesn't suggest that the man step outside to cool off. Instead, he handcuffs the perpetrator and takes him to the police station, where he will be booked and jailed, while another officer offers to escort the wife and her children to a shelter. Violence against a woman in her home is now defined as a crime by our society, and the criminal justice system treats it as such.

But has this enormous revolution in both public perception and public policy made America less violent? Are there fewer batterers than before? Are batterers learning to take responsibility for their behavior? Are women safer or more in control of their own lives? Unfortunately, after years of researching this social problem, I can't answer any of these questions with a resounding yes. What's more, the ideology and rhetoric of the anti-domestic violence movement have become so rigid that they have created a new set of myths—or, at the very least, a new set of highly partial truths—that can be as pernicious as those we fought to dispel years ago.³²

Feminists may understandably take issue with criticism of Walker, noting that it is Walker's work that has jumpstarted research and advocacy for battered women. This, precisely, is the crux of the problem. Just because someone means well doesn't mean they don't have to play by the rules; Walker's work should have been the beginning of an important study, not the end of it. Is it justified for good intentions to mask bad science—especially when it is to the ultimate detriment of many?

Both Lenore Walker and Carole Alden could serve as exemplars in seeking answers to that question.

ACCEPTING THAT GOOD PARENTS
MAY PLANT BAD SEEDS—
BUT THERE IS A DEEPER TRUTH

One thing that science is becoming clearer about is that good parents can sometimes, for whatever reason, have a child who has real difficulties grappling with life, or who even turns out badly. Perhaps such behavior could be due to a high fever in utero from chicken pox that sends a few critical cells offtrack, or inadvertent exposure to diethyl-stilbestrol, or any number of other unfortunate environmental influences. Or, such children might simply have been afflicted with an ill-fated confluence of genes, as with the probable partial role of genetics in predisposing Marty Sessions and his siblings to their addictions. “Accepting That Good Parents May Plant Bad Seeds” is the title of a recent New York Times article by psychiatrist Richard Friedman. In the article, Friedman's colleague, Dr. Theodore Shapiro, a child psychiatrist at Weill Cornell Medical College, points out: “The central pitch of any child psychiatrist now is that the illness is often in the child and that the family responses may aggravate the scene but not wholly create it…. The era of ‘there are no bad children, only bad parents’ is gone.”33

Conner Rusek, Carole's oldest son, inherited a mix of features from both sides of the family—he has dark-blond hair that might be wavy if he were to let it grow, a husky build, and a deceptively unhurried demeanor that belies his intellectual horsepower—he shares with his father the distinction of being a “brainiac.” Despite his early hopscotching around the country, the intellectually advanced Conner was accepted into a high school gifted and talented program. Unfortunately, this program required that Conner go to school on certain days to “check in,” after which he was supposed to work at home on self-directed projects. But Conner already had his hands full at home—other family members observed that Conner's chief duty often seemed to be babysitting his younger half-siblings, Jason and Emily. Without support, the gifted young man's education floundered. He began to experiment with drugs and alcohol.

Brian Poulson, Carole's second husband, was very different from Richard, her first. Brian allowed himself to be drawn into Carole's dramas—the two would become involved in lengthy scream-fests observed by the children. Carole always had the advantage in these battles, since her five offspring had been trained to come down on her side no matter what happened. Conner was just one among many in the audience, cheering Carole on. One evening, the drunken Conner, then in his late teens, was pulled in as a collaborator in Carole's fight with Brian, during the course of which Conner took an ax to his stepfather's possessions.

But Carole's response to Conner's violent action on her behalf was not only unexpected; it turned Conner's world upside down.

The frightened Carole called the police. Conner was arrested and jailed. In the resulting legal proceedings, the cost of Brian's destroyed belongings was estimated to be high enough that it changed the nature of the crime—turning it into a felony. Conner ended up in prison.

Even after what his mother had done to him, Conner still attempted to build bridges—to reestablish contact with Carole once he'd finished his stint in prison. However, the counseling he received while in a halfway house helped him put his mother's behavior in perspective. Thus, to Conner's credit, when Carole reacted to him with the same entrenched patterns, he decided to break off contact rather than getting sucked back into the same dysfunctional interactions. Conner's continuing positive relationships with both his father and, perhaps surprisingly, his stepfather Brian, have helped him. Neither Richard nor Brian, Conner noted, ever asked him to choose between them and his mother. With Carole, however, you were either with her or against her. There was no middle ground.

Conner's sister Melloney had seen what happened to Conner when he had upset his mother. It is a tribute to Melloney's integrity, and her concern for her own children, that, in the case of Marty's killing, she defied her mother and told the truth to police—she admitted that her mother had asked her to lie.

One official who listened in on telephone conversations between the imprisoned Carole and her son Conner observed that Conner was legitimately appalled at his mother for the position in which she'd placed Melloney in, after the killing, even as Carole professed to being seriously concerned for her oldest daughter. “The phone call between Conner and his mother, ironically enough,” noted the listener, “was probably one of the few moments in observing the case from outside where I realized I was listening to someone become flat-out disgusted with Carole's behavior through just plain decency and common sense. I know that probably does not make sense to anyone but me.”

The abrupt jolt of being pulled as a collaborator into his mother's fight and then betrayed by her was the major shock Conner needed to break the spell of such an expert manipulator. To his great credit, Conner has moved beyond his traumatic early experiences and profound betrayal. He is happily married now. Entirely self-taught, he has become a highly skilled web designer. With the template of victimization he was raised on, his life could have easily gone in a different direction. But Conner took the reins of his life firmly in hand and steered toward sunlight.