Psychiatry and the Heart of Darkness

Ronald W. Pies, MD;

Psychiatry and the Heart of Darkness

November 30, 2009

Ronald W. Pies, MD

Publication

Article

Psychiatric TimesPsychiatric Times Vol 26 No 12

Volume 26

Issue 12

The press reported it in various ways-either as a “brutal gang rape” or, more forensically, as a “21/2-hour assault” on the Richmond High School campus. Any way you look at it, the horrendous attack on a 15-year-old girl raises troubling questions for theologians, criminologists and, of course, psychiatrists. How do we understand an act as brutal as rape? What factors and forces in the rapist’s development can possibly account for such behavior? And how on earth do we explain the apparent indifference of the large crowd that watched the attack in Richmond, Calif, and allegedly did nothing to stop it-or even, to report it?

In a thoughtful analysis on CNN, Stephanie Chen provides a range of “expert opinions” on this last question. Essentially, the various hypotheses asserted that:

• Bystanders in large groups are unlikely to take appropriate action in such cases, because they assume that others have already done so or because “doing nothing becomes the norm” (the so-called bystander effect).

• Witnesses who might have phoned 911 may have feared retaliation from the perpetrators.

• Bystanders do not feel a “bond” with the victim, and may actually identify with the perpetrator, who is perceived as “more important” than the victim.

The CNN report speculated at length on the so-called Genovese syndrome, named for the woman stabbed to death in Queens, NY, in 1964-supposedly after 38 witnesses to the attack did nothing to help her. The facts, however, are almost certainly otherwise, as an article in the American Psychologist argues. Indeed, the authors concluded that “there is no evidence for the presence of 38 witnesses, or that witnesses observed the murder, or that witnesses remained inactive.”

Even in the case of the Richmond High rape, it now appears that at least 1 person-Margarita Vargas-did notify the police.¹ However, as ABC News reported it, Vargas was not a witness to the rape. Rather, “the 18-year-old mother and former Richmond High School student was at home watching a movie when her brother-in-law came home and said he had seen a girl getting raped.” It is remarkable that this man seems to have brought the news to Vargas with the same sense of urgency as someone who had just witnessed a fender-bender. Reportedly, he was “scared”-so perhaps we ought to allow for some degree of shock, and perhaps fear of retaliation.

Nevertheless, media reports on the Richmond High rape have largely ignored the moral implications of the bystanders’ failure to aid the rape victim. Thus, the forensic experts, quoted in the CNN piece, took a predictably “objective” point of view. None ventured the opinion that the crowd at Richmond High School failed to help because many human beings often act in a selfish, callous, and cowardly manner.

Nobody put forth the view of rabbinical Judaism that we are all born with 2 primal inclinations, constantly at war with one another. The “good inclination” (yetzer hatov) is usually considered a kind of late “add-on” to the more powerful “evil inclination” (yetzer hara), which often gains the upper hand. The yetzer hara seems to have been alive and well at Richmond High-and nobody there lifted a finger to stop it. Rabbi Bruce Kadden, however, points out that the yetzer hara is not some “devil” external to our own selves, rather “it is very much a part of us. We therefore cannot deny personal responsibility for what the yetzer hara causes us to do. It may explain our behavior, but it does not excuse it.”²

The problem of human evil, however defined, has arisen in a number of recent events that have been subject to lengthy psychological analyses; eg, the mass shooting at Fort Hood [see related cover story] and the attack on a 15-year-old boy, who was set on fire by 5 other teenagers.³ Yet many psychiatrists, it seems to me, have been reluctant to venture into the obscure headwaters of evil-the territory explored so vividly in Josef Conrad’s 1902 novella, The Heart of Darkness. Many in our profession have taken the “scientific” view that matters of good and evil are best left to theologians and clergy and that clinicians should limit themselves to analyzing and correcting the developmental, biological, and psychological precursors of so-called antisocial behavior.

I disagree. As mental health professionals, we may rightly insist on examining any behavior, however heinous, in terms of its psychopathological roots. In so doing, we may invoke any number of biological, social, and psychological “explanations.” Yet psychiatrists and other mental health professionals should not avoid moral issues, or moral narratives, when considering violent antisocial acts. After all, the constructs of good and evil are very real, and matter very deeply, to most of our patients.

Indeed, a woman who presents in therapy with a rape-related traumatic syndrome may be said to embody the problem of human evil: even her physiological responses to trauma-related stimuli have been altered by her experience. But more than that, the patient (male or female) who has suffered a brutal assault may need to explore the moral dimensions of the act and its consequences: “how could another human being do such a horrible thing? And-why me, Doctor? Was I being punished by God? Am I somehow responsible for what happened? What should I do with all the hatred and rage I feel toward this monster? Is it right that I want him to suffer as much as I have-and even have thoughts of killing him? Does this make me evil, too, Doctor?”

These understandable moral questions do not arise for all victims of trauma; but when they do, psychiatrists must be prepared to engage the patient in a serious “I-Thou” dialogue, to use Martin Buber’s term. Similarly, philosopher and ethicist Margaret U. Walker has written of the need for “moral repair” after an act of wrongdoing.

As therapists, we help effect such repair by establishing trust-the first step in mending the torn fabric of the traumatized patient’s moral universe. To gain the patient’s trust, however, we must be ready to talk frankly and comfortably about good and evil. Sometimes, this means confronting the enormity of acts such as those that occurred at Richmond High.