Let me lay my cards on the table right now: as a psychiatrist, I’ve long been a skeptic of Dissociative Identity Disorder (DID), at a minimum perceiving its overdiagnosis. Once known as Multiple Personality Disorder, this is the condition where individuals become so disconnected from their bodies and surroundings that they assume other identities, or “alters.” For those who give credence to this diagnosis, it’s understood that DID arises as a defense against severe childhood trauma, where a stronger alter absorbs the violence, while other personalities self-protectively retreat from the terror.
In 26 years as a physician, I’ve only seen one compelling case of this condition. By contrast, I’ve had a handful of run-ins with quack therapists who manipulate vulnerable patients into embracing their alters and false memories of Satanic ritual abuse.
Adding breadth and nuance to my clinical experience is Alex Gibney’s latest documentary, Crazy, Not Insane. In this profile of the life and work of forensic psychiatrist Dorothy Otnow Lewis, we’re told that the source of DID is not cultic trauma but horrific abuse suffered in one’s own home.
Lewis has interviewed 22 serial killers, not to mention countless other murderers and violent offenders. In her research, some published by the most reputable medical journals and twice cited in Supreme Court decisions, she has discerned a triad of factors that commonly create a violent criminal: brain damage, childhood trauma, and psychiatric disorder. In some cases, the latter is diagnosable as DID.
This was hardly the received wisdom when Lewis discovered this pattern in her work at New York’s Bellevue Hospital. Crazy, Not Insane fascinatingly chronicles the route to these findings with video excerpts of her clinical interviews. Looking over Lewis’ shoulder, we see Rochester serial killer Arthur Shawcross, plus a young man who stabbed a pair of lovers, assume different personae before our eyes.
(Here is as good a place as any to issue a trigger alert and a caution. Crazy, Not Insane doesn’t stint on violent, and sometimes sexually violent, words and imagery to tell its story in a non-titillating fashion. Even though I’ve heard hundreds of trauma narratives and treated accused murderers and rapists in prison settings, I found this film unsettling. Furthermore, it would be regrettable if viewers took away an unintended message that trauma survivors are typically violent themselves. The majority of such individuals are solely victims, not perpetrators.)
The balance of Gibney’s film tilts towards Lewis’ lifework and that of her ideological fellow travelers in psychology, neurology, and criminal law. However, we do hear from a DID skeptic. Park Dietz is one of the two or three “celebrity” forensic psychiatrists in my professional subculture. In his interviews, including one specifically for this film, Dietz doesn’t come out smelling so good. Calling DID a hoax, he flatly denies that it’s insane for a serial killer to eat a victim’s vagina, but merely a creative way to dispose of evidence. In the 1980s, he sided with James Dobson in laying the blame for Ted Bundy’s murderous sadism on pornography, stating it’s a deadlier social influence than assault rifles.
By contrast, Dr. Lewis impresses with her integrity. (It’s always a notch in the plus column when a scientist can humbly admit their earlier data interpretations were erroneous, showing a capacity to change their mind.) Lewis argues not for laxity in confining dangerous actors, but that madness should be punishment enough without applying the death penalty. To demonstrate the tragically low bar used by courts to determine competency to stand trial, she cites the example of Ricky Ray Rector. Arkansas Governor and Presidential candidate Bill Clinton presided over the execution of Rector, a man so intellectually impaired that he set aside the pecan pie from his last meal for consumption after his lethal injection.
Near the beginning of Crazy, Not Insane, Dr. Lewis postulates that her obsession with the psychology of murderers stems from a childhood haunted by the Nuremburg Trials. Through crafty editing, Gibney implies that the Americans closest to the Nazi spirit are not those executed, but the bloodthirsty ones who stand outside prisons and cheer the executions.
Gibney uses his complete documentarian bag of tricks to ensure that Crazy, Not Insane is perpetually engrossing. Sections of Lewis reading snippets from her books and articles alternate with matter-of-fact voiceover by Laura Dern. Video of subject interviews and court proceedings, audio from Lewis’ last conversation with Ted Bundy, and inspired animation (I loved the Rorschach inkblots brought to life!) form an aesthetically satisfying collage.
However, some of the narrative threads are undeveloped. We briefly hear of Lewis’ deceased husband, meet her son and daughter, and observe her during an art lesson, but these intervals are so flimsy that they feel like inessential distractions.
Still, I value the insight gathered along this film journey. I’ve learned to trust Gibney as a truth-teller, a filmmaker content to let his narratives envelop his viewers sans embellishment or fabrication. (I’ve previously written appreciations of his lifework here, here, and here.) So I welcome his and Lewis’ challenges to my prior clinical notions; they have the potential to mold me into a better psychiatrist and a more empathic human being.
(Crazy, Not Insane has its HBO premiere on November 18th.)
(Image credit for star rating: Yasir72.multan CC BY-SA 3.0 )