THE MASK OF SANITY

Judging from last Tuesday's (June 29) NY Times, I've been wrong about parents' maintaining standards and values, giving guidance and controls to their children (so that they don't end up killing people or committing suicide). The parents of Dylan Klebold and Eric Harris refuse to be interviewed, but the Times reporters got information from friends, neighbors, teachers and classmates, and the net result, in a full page text seemed to reveal that the parents were normal and good.

Must we conclude that media violence, a materialistic society and the availability of firearms makes perfchloe.com multiple murders and suicides inevitable? Or, considering that humankind has been prone to killing since recorded history, we are merely dealing with the human condition?

Given our species' tendency to strong instincts and weaker controls, murders are bound to happen. Fortunately, these instances are relatively rare, so that when they occur, they are considered newsworthy, and people want to know why. Many murders have been called 'senseless', because there seems to be an absence of an understandable motive.

What I got out of reading the full page of text about the two Columbine killers was that they cleverly eluded detection, even from parents, even from a psychiatrist, who had Eric Harris on an anti-depressant (Luvox) and seeing him once a month. It is easy to say, in retrospect, that in all probability, the dose was too low and the visits too infrequent. If Eric was manic-depressive, he would have needed more frequent visits and adequate doses of not only an anti-depressant, but a mood modulator.

As it was, both boys were 'cool' enough to hide their terrible plans and preparations, by going to school, getting good grades, working part-time and showing an outward, if weird demeanor. Such people can fool even a well-trained psychiatrist. If the person does not tell the therapist the whole truth, the 'therapy' is flawed. Only in an atmosphere of mutual trust and respect can psychiatric treatment really work. These boys were planning for a year to shoot and bomb their classmates, and nobody could tell. There were premonitions of disaster in their English school papers and websites, but nobody paid that much attention.

The fact is, that serious psychopathology can be effectively covered up. We all know people who act crazy (grossly irrational) from time to time, and we make allowances or keep our distance, but sometimes people who are grossly disturbed do a great job of covering it up.

There are prime examples in recent years. Jeffrey MacDonald, ("Fatal Vision"), a Princeton educated medical doctor, was finally convicted of murdering his pregnant wife and two young daughters. He always acted normal and said his family was murdered by a crazed Manson-type marauding group, who killed wantonly and randomly. The forensic evidence and implausibility of his explanation led to his conviction, but he has spent considerable time and effort trying to clear his name. How could an army captain, a doctor, a responsible family man, have slaughtered his family? He always presents himself as decent, polished, articulate, intelligent and even creative, so we tend to think he couldn't have done it. He hid his psychopathology well.

In November of 1992, New York's chief judge, Sol Wachtler, an heir apparent to the governer's mansion was arrested. He was charged and convicted for a humiliating crime stemming from his manic and obsessive harrassment of his former mistress. He was guilty of extortion, harrassment and kidnapping threats. Here we have a man who seemed to be the soul of integrity and was a highly esteemed legal scholar. His friends and associates were dumbfounded at the arrest, and even more so, when the evidence was undeniable. It is hard to picture the same man holding forth in the highest court of the state of New York, and skulking around pay phones, finding odd times to be making threatening phone calls. For a long time, he acted normal and got away with it.

In recent years one of the world's most famous psychoanalysts, an emeritus professor of psychiatry at Northwestern University in Chicago, was accused of having sex with women patients in his office. He was using intravenous amytal, otherwise known as 'truth serum' to facilitate the process of psychotherapy. One of his patients woke up while he was still raping her, and proceeded to press charges. Nobody would take her case at first, because Jules Masserman was so esteemed as a teacher and writer. It was her word against his. But she wrote a convincing book, "You Must Be Dreaming," which revealed previous accusations that were settled out of court with a gag rule. Dr. Masserman proclaimed his innocence till his dying day, but he was dismissed by the Illinois State Psychiatric Society, the American Psychiatric Association and the American Academy of Psychoanalysis. Ironically, he was a founding member of that latter organization of psychoanalysts. His outward appearance was always smooth, polite and ingratiating, but his private behavior was gross.

There's a book on the subject, "The Mask of Sanity" by Hervey Cleckley. The title says it all.

Dr Bloom is Clinical Associate Professor of Psychiatry, Wayne State University School of Medicine. He is a member of the American Academy of Psychoanalysis and on the editorial board of the Wayne County Medical Society. He welcomes comments at his email address--- vbloom@comcast.net.