1.2.1. Serial killing and mass murder
Despite some disagreements in the literature concerning a definition of serial killing, it is most often defined by; “the intentional killing of at least three or more individuals in a series, with a latency period between the killings”. (Meloy & Felthous, 2004, p. 289). This is in contrast to the “mass murder”, which means the intentional killing of at least two or three individuals in one event. Most mass murderers use a gun, indicating a certain emotional distance to the victims in opposition to most serial killers, who seems to be concerned with the act of the killing, and often, though not always, involves sexual rituals (p. 289). Mass murderers and serial killers do this way appear in different forms. Because of that, mass murderers will not be directly considered in this work, even though it seems likely that they share some of the same characteristics as serial killers.
1.2.2. Psychopathy, sociopathy, antisocial and dissocial personality disorder
There seems to be a general tendency among people to associate serial killers with the term “psychopath”. There are, however, massive disagreements in the current psychiatric classification concerning socially harmful antisocial persons. The term, psychopathy, is often used interchangeable with concepts such as “sociopathy”, “antisocial”- and “dissocial personality disorder (PD)”. But the meanings of these terms are not identical. The term, sociopath, is the least used nowadays, having no actual diagnostic tool besides the first edition of DSM. This term was introduced in 1952, as the phenomenon of antisociality was seen to be developed purely as a consequence of social factors and not as well by psychological, biological and genetic factors as indicated in the term, psychopath. It was also used to avoid the confusion of the words’ similarity with the term “psycho”, which has a totally different meaning (Hare, 1999). However, professor in psychology, David T. Lykken, has maintained to use the term sociopath, when referring to “persons whose unsocialized character is due primarily to parental failures rather than to inherent peculiarities of temperament” (1995, p. 7). But making a decision concerning whether the antisocial behavior is a result of the parents’ upbringing or due to inherent factors, can seem problematic, and maybe also unethical. Antisocial PD is nowadays used in the American diagnostic tool DSM-IV, whereas dissocial PD is used in the European diagnostic handbook, ICD-10. Psychopathy is not considered in any of these classification systems, but is diagnosed with the use of a diagnostic tool that is developed by Robert Hare “The Psychopathy Checklist” (PCL-R). He based the 20 diagnostic criteria that it is containing, on the 16- item psychopathy checklist that was made by Hervey Cleckley in 1942 (Hare, 1990; 1995, p. 106). Hare and Cleckley seem, when studying literature about psychopathy, to be, or have been, some of the most prominent experts within the field of psychopathy.
The following is an illustration of the differences between the four terms:
|Antisocial PD (DSM-IV): Three or more of these criteria have to be present in addition to pattern having lasted since age 15 and also evidence of conduct behaviour before age 15 (Gabbard, 2000, p. 493).||Dissocial PD (ICD-10): Three or more of these criteria have to be met. Additionally, the behavioural pattern must have endured since childhood or adolescence and the general criteria for a personality disorder has to be present (WHO, 2002).||Sociopath (DSM): These criteria are, according to Hare (1970, p. 4), from the first DSM from 1952 and the present of all of these symptoms is characteristic.||Psychopath (PCL-R)|
|1)Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.||2)Disregard for social norms, rules and obligations;|
|2)Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.||2)Gross and persistent attitude of irresponsibility.||Lack of responsibility||15)Irresponsibility|
|3)Impulsivity or failure to plan ahead||Impulsivity (one of the general criteria for personality disorder).||13)Lack of realistic, long term goals. 14)Impulsivity.|
|4)Irritability and aggressiveness, as indicated by repeated physical fights or assaults.||4)Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;|
|5)Reckless disregard for safety of self or others|
|6)Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.||No real loyalties.||4)Pathological lying 5)Conning and manipulativeness 6)Lack of remorse or guilt.|
|7)Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another.||5)Incapacity to experience guilt.|
|Pattern occurring since age 15||Pattern lasting since childhood or adolescence||Chronically antisocial||12)Early behavioral problems|
|6)Marked proneness to blame others, or to offer plausible rationalizations, for the behavior that has brought the patient into conflict with society.||Ability to rationalize their behavior so that it appears warranted, reasonable and justified.||16)Failure to accept responsibility for own actions.|
|3)Incapacity to maintain enduring relationships, though having no difficulty in establishing them;||l7)Many short- term marital relationships.|
|5)Incapacity to profit from experience, particularly punishment;||Profiting neither from experience nor punishment|
|I)Callous unconcern for the feelings of others||Frequently callous||8)Callousness and lack of empathy|
|Always in trouble|
|Marked emotional immaturity|
|Lack of judgment||9)Parasitic lifestyle|
|10)Poor behavioral control|
|11)Promiscuous sexual behavior|
|19)Revocation of condition release|
|1)Glib and superficial charm|
|2)Grandiose self worth|
|3)Need for stimulation or proneness to boredom|
The symptoms for the different diagnosis are overall quite similar, and the symptoms that are approximating identical meaning are, in the diagram, put together in the same line. Symptoms that are not put together in lines, however, are symptoms that have a different meaning than symptoms from the other diagnosis and can contribute to a differential diagnostic outcome.
The PCL-R is a list of 20 symptoms, where each of these items is scored with a 3-point scale (0, 1, 2). Points are given depending on how well it fits the individual. The score one is able to get, is this way between 0 and 40. To be diagnosed as a psychopath, one has to get a minimal of 30 (Hare, 1996). This indicates that meeting the criteria for psychopathy is more difficult than meeting the antisocial diagnosis, where only three or more of the criteria has to be met. This might explain that the prevalence of psychopathy is found to be lowest with only 1% whereas antisocial PD is 3%. In relation to the antisocial PD and psyhopathy, it can seem like it would be right to say that psychopathy is as a subgroup of antisocial PD, as psychopaths most often meet the criteria for antisocial PD, and it is rare to be a psychopath without meeting the criteria for an antisocial PD (Gabbard, 2000, p. 493). As for ICD-10’s related diagnosis, the dissocial PD, this actually includes the antisocial, psychopathic and sociopathic PD’s (WHO, 2002, p. 202), which indicates that this prevalence is higher than the other two. But as for exact prevalence of dissocial PD, there does not seem to have been conducted ambitious research (Rosenquist & Rasmussen, 2001, p. 201). This is probably as most of the research in this field seems to have been conducted in the US, where DSM-IV and PCL-R are mainly used. For this reason these terms are also mostly referred to in this work.
Narcissistic personality disorder is a diagnosis in DSM-IV, and is indicated by a pattern of grandiosity, need for admiration and a lack of empathy (Gabbard, 2000, p. 266). This diagnose does, however, not exist in ICD-10. This is doubtfully due to its non-existence outside the US, as it probably rather reflects the methodological challenges there are with diagnosis.
According to self psychologist, Heinz Kohut, it is a problem that the term narcissism is attached to one single personality disorder, as he claims that narcissism is a fundamental and essential dimension within every human being. Narcissistic pathology occur, when the self fails to develop in a mature manner, and continue to have an exaggerated need for being gratified and recognized from others people. This is as the self has not learned to regulate itself. This way, Kohut’s term of narcissism, does not directly referrer to what is meant by a narcissistic personality disorder in DSM-IV, even though the symptoms can be seen as related (Kohut, 2000, p. 27; Karterud & Wilberg, 2001, pp. 51-52). Kohut does not pay attention to the terms antisocial or psychopath, in his theory. He does instead refer to antisocial behaviours as “narcissistic ” (Kohut, 1978, pp. 634-635). Also Otto Kernberg who has been occupied with the disorders of narcissism, claims that narcissistic pathology is placed on a spectrum. This way, he ranges severity of narcissism, from a “narcissistic personality disorder” to “malignant narcissism “and to “antisocial personality disorder”, which is the most severe form for pathologic narcissism (Kernberg, 2003, p. 373). Out of these understandings of narcissism, and its link to antisocial behaviour, narcissism will be an important term in this work. Thus, when narcissistic personalities are referred to in this work, it does not necessarily referrer to the DSM-IV diagnosis, but it is more linked to the assumed presence of a narcissistic pathology (Kohut, 1978; Kernberg; 2003).
When the general public express their opinion and reactions in relation to serial killers, one often hear serial killers be referred to as, on one hand; evil, wicked, cruel and bad, or, on the other hand as; sick, ill, pathologic and mad. This indicates that one might overall separate the understandings of serial killers into two rather different categories. A presentation of some ordinary ways to define the terms evil and mentally ill/disordered will, because of that, be given in the following. As for evil, there are countless ways to understand and define its appearance. Traditionally (especially within a Christian point of view), evil has often been referred to as “…acts, and sometimes thoughts and ideas, commonly known as sin, that are thought to originate with Satan and challenge the law or will of God” (Wickipedia.org). This definition is stated in an online encyclopedia, which has also defined evil as something that is “morally bad”, “corrupt”, “destructive”, “selfish” or “wicked”. Within a respectively psychological and philosophical perspective, however, Roy F. Baumeister (1999) and Lars H. Svendsen (2002) have both written books about evil, where they define evil as something that involves an intentional wish to hurt other people (Baumeister, 1999, p. 8; Svendsen, 2002, p. 19). Kuschel and Zand (2004) criticize these definitions, as they claim that Baumeister and Svendsen, with their definitions, do not see evil as distinct from what is meant with aggression. Kuchel and Zand have defined evil in their book “Ondskabens psykologi” this way: “those that in their character are extreme and cross-frontier in the cultural and social context where they appear, and have as a purpose to reduce others’ quality of life (physically and/or psychological) and when the act is committed without empathy for who it is affecting.” (2004, p. 17. My translation). Thisdefinition seems to be consistent with what people in general are referring to when they talk about evil, and this definition will such be used as the basic underlying meaning, when referring to evil in this work. The dispute of whether to referrer to serial killers as evil or as ill, will be discussed later in this work. First is a presentation of how one can understand mental disorders.
1.2.5. Psychopathology and mental disorder/illness
There exist remarkable little agreement and accuracy in a definition of psychopathology and mental disorder/illness. In a psychological encyclopedia, psychopathology is defined as a mental disorder or deviance (Hansen et al. 1999, p. 324) and mental illness/disorder (Danish sygdom) as something that threatens the personality and that can be manifested in inadequate reactions (p. 320). These definitions can seem to have limited utilizability, as they can be argued to be somehow circular in their nature, and to be difficult to use when deciding who should be termed as having a mental disorder or illness.
The Danish research professor, Gretty Mirdal (2001), makes a clear definition of mental disorder/illness (Danish; lidelse). She defines it as the “patient’s subjective experience of being sick”, whether there are objective symptoms or not (p. 6. My translation). A definition like this seems, though, to involve a significant problem. If one is asking a person with schizophrenia, who experiences being controlled by aliens from another planet, he might answer negatively to the question if he is sick This way, an individual that is both severely paranoid and delusional, is not defined as having a mentally illness or disorder as he does not necessarily have the “subjective experience of being sick”. However, it might be that other people, like for example relatives, are feeling substantial discomfort.
Taking this aspect into consideration, Adrian Raine (1993), a professor in psychology, states that he has collected the definitions that have received most attention in the literature and thus what is usually seen as disorders. These definitions are; distress/suffering to self or others, deviation from a statistical norm, deviation from ideal mental health, deviation from the social norm, seeking out treatment, impairment in functioning/efficiency, listed in DSM and biological dysfunction (pp. 3-17). (It is also to be notion in relation to this, that the title of the “Diagnostic and statistic manual of mental disorders” (DSM), indicates that all of the diagnoses in this manual can be termed a mental disorder). These definitions of Raine will be the considered ones when the relation between mental disorders and serial killers are discussed.
Niels Reisby, having written some chapters in the book of Hemmingsen et al. (2000) “klinisk psykiatri”, states that mental illnesses is about a continuum, where it stretches from normality to severe degrees of mental disorders, in which the less ability the person has to participate in the “normal societies activities”, the more severe is the disorder (pp. 31-32. My translation). This understanding of mental disorders as a continuum will also be considered when discussing serial killers’ potential mental disorder. This is, as it will be illuminated where, on the continuum of “normal society activities”, a serial killer can be found.