Wednesday, April 16, 2008

Do You Believe in Evil?

by Lucy Puryear, M.D.

My last post referenced the case of
Joshua Mauldin, a 20-year-old man found guilty of putting his two-month-old daughter in a microwave for ten seconds. The defense was hoping he would be found not guilty by reason of insanity. That plea was rejected by the jury and he was sentenced to twenty-five years in prison.

In reality, less than 1% of defendants use
the insanity defense, and of those who do, less than 20% are successful. That is a good thing. We want people who do bad things to be punished. We most certainly want them put in an environment where the chance that they will re-offend is limited. We also don't want lawyers and their clients to abuse the insanity defense and make it less effective for those who are truly and severely mentally ill.

So if Mr. Mauldin wasn't insane, what was he? And was he fully responsible for the crime he committed? I know I have just raised the hackles of several of our contributors, but hear me out. How do we explain what causes people to commit heinous acts of violence against others? In Mr. Mauldin's case, the defense tried to claim that he had a long history of mental illness and at the time of the crime was unaware of what he was doing. The jury didn't buy that explanation.

But Joshua Mauldin did have some form of mental illness as testified to by both the defense and the prosecution experts. Was he adequately treated? Did he have appropriate follow-up to assure that he was on the proper medication and that he had been taking it as prescribed? Was he depressed? Psychotic? Not an excuse, but a factor? The legal system even allows for mitigating factors to be considered when deciding upon a sentence. Rage, passion, mental illness, poverty, and abuse are acknowledged as possibly contributing to the perpetration of a crime.

As I psychiatrist I often try to understand why people do the things they do . . . hopefully so they can stop making bad decisions that hurt themselves or others. When someone commits a violent crime it's often not that hard to understand why. A psychotic person hears Satan's voice telling him to kill. A pedophile was sexually abused as a young child by a close family member. A teenager panics when she delivers a baby she's told no one about. These explanations help us to make sense out of how someone can do some things so awful to others and give us some hope that we might be able to prevent future tragedies. We can make sure there is access to psychiatric care, we can work to identify children who are being abused and get them help, and we can set up laws that allow mothers to turn over infants to hospitals or fire stations (Baby Moses Law).

But I must admit, after I count up the mentally ill . . . and the abused . . . and the neglected . . . and the disenfranchised . . . how do I account for those who, despite fairly reasonable upbringings, inflict terrifying and horrific acts against innocent others? I want to find some brain disorder, some chemical imbalance that makes sense of this for me. I don't believe people are born to commit atrocities. And yet . . .

There are some whose eyes you look into and see darkness. Despite my best efforts I can't find a way to make human contact--find that piece of them that connects to others. Often these people are good at "pretending" to be human. They have studied others and can mimic appropriate reactions or responses. But inside there is no true capacity to know or care what another thinks or feels. In his novel No Country for Old Men, Cormac McCarthy depicts a character, played by Javier Bardem in the film adaptation (pictured above), who kills and makes sport of it. He enjoys the chase and the terror that his victims experience as he flips a coin to decide whether they live or die. It gives you chills as you watch this inhuman human, kill.

Medical science is trying to find the cause and hopefully the "cure" for people without a conscience. At the moment there is no medication nor therapy that has been very effective. It is hard for me not to want to find a reason for the horror: brain damage at birth, poor nutrition, maternal deprivation? It is hard for me as a healer not to want to heal. And yet I must acknowledge I am helpless. And maybe there is just such a thing as evil.


Unknown said...

When I read PEOPLE OF THE LIE by M. Scott Peck many years ago, I suspected that he was correct--there are the evil who walk among us. Then I did multiple interviews with serial killer Tommy Lynn Sells and I knew it was true. Could Tommy benefit from psychiatric treatment? Not now. Maybe when he was a small child. He enjoys inflicting pain and death and feels justified in doing it. I can't think of anything that defines evil better.

Lucy Puryear MD said...

I agree Diane that by the time adulthood is reached there is little hope for a true psychopath. It is disheartening to imagine that there is nothing that can be done to change the outcome of a life. It is why I am so passionate about early intervention for mother's and their children. With early treatment of the family we may be able to save lives.

Anonymous said...

Diane...that [People of the Lie] is exactly what I was thinking. Scott Peck was brilliant.

I believe in pure evil but it took me a long time to get to that point. I think as kids most of us are read to many fairy tales by our parents and we grow up avoiding the issue of evil and refuse to see it. Sometimes there is no other explanation.

I don't know why we think we have to have a name and a reason for everything. Some people are just "sick" and the legal defnition for insanity will never match a mediacal one.

Anonymous said...

I think we try to name things so that we can hopefully make changes in the outcome. Psychiatric illness is no different from diabetes, or cancer, or heart disease. If we can understand what causes it maybe we can stop bad things from happening.

You are right that the legal definition of insanity will never match the medical one. But I believe we ought to be closer than we currently are.

Anonymous said...

"I think as kids most of us are read to many fairy tales by our parents and we grow up avoiding the issue of evil and refuse to see it."

I part. I think most responsible parents DO try to acquaint their children with the concept of evil ('Don't talk to strangers"), but riding that fine line between educating our children and scaring them to smithereens is a hard task. I also think that many children have an instinctive, if undefined, sense of evil - "the monster in my closet".

Course, no amount of educating on the part of the parents can change the invincibility of youth. Yes, we can caution them to stay out of that stranger's car, but we can't entirely eliminate the youthfully ignorant attitude of "it can't happen to ME". Not really a case of refusing to see evil as much as believing evil is selective.

Unknown said...

So right, Rae! My mother injected me with an overdose of fear. I think my response was to downplay it all too much with my kids. Hopefully, my grandchildren will get the happy medium.

Anonymous said...

Exactly, Diane. It's hard to find that middle ground, and, sadly, there are no guarantees, even if you manage to walk that fine line.

As an example, I always cautioned my eldest daughter against using drugs and alcohol. As a recovering addict of nearly 20 years, I understood the damage a person can inflict on themselves when they abuse substances. In the end, though, I went overboard, and, unfortunately, I think my preaching about illicit drugs made trying them tempting to her-sort of a 'forbidden fruit' mindset. That's the conundrum-instilling a healthy caution in your children without either making them terribly paranoid or, the opposite effect, making bad things appealing.

(By the way, I LOVED "Out There" and "Baby Be Mine" - both terrific books. It did make me sad for Lisa Nowak, to read that book and understand exactly the years of education and hard work that she lost.)

Dr Puryear, I did want to comment on this: "I want to find some brain disorder, some chemical imbalance that makes sense of this for me. I don't believe people are born to commit atrocities. And yet . . ."

I have to think that some people ARE born to commit atrocities. The human brain is such a mysterious and complex thing-if a child can be born with autism or other developmental disorders, then doesn't it stand to reason that they might very well also be born with some malfunction that develops into sociopathic tendencies?

Unknown said...

Thank you for your kind words about my books, Rae. I, too, was very saddened by Lisa's meltdown.

Anonymous said...

I have read The Biology of Violence by Debra Niehoff, Ph.D. and The Sociopath Next Door by Martha Stout, Ph.D. I think through neurobiological studies that include brain mapping and imaging, they do have a pretty good grasp that there are some who are just evil and absolutely no remorse. And...they do know the cause.