Reviewed by Joyce Alexander, RNP (Retired)
I bought The Psychopath Test—A Journey Through the Madness Industry, by John Ronson, based mainly on the title. Jon Ronson is a journalist and author of two previous books that were widely accepted. A movie was made about one of them, The Men Who Stare at Goats, starring George Clooney. The first couple of chapters of this book weren’t all that interesting to me, but before long I was hooked into the story he was writing.
Mr. Ronson looks at the “madness industry” from an outsider’s point of view. He actually took training from Dr. Robert “Bob” Hare in how to use the Psychopathic Check List-Revised to spot a psychopath. Ronson went a few steps further, though, in his learning about commercial psychiatry, and the industry that has grown up around the DSM II-V, defining what is and what is not “madness.”
Dr. Robert Hare, as we know, was the developer of the PCL-R, which is similar to the “cook book” diagnostic manual for psychiatry (DSM), with check lists of symptoms for definite diagnostic criteria to define and “diagnose” what is normal behavior and what is not. There were some interesting discussions documented between Ronson and Dr. Hare about the validity of the PCL-R and where the “cut off score” should be.
Ronson gave the history of the development of the DSM, which has expanded with numerous added “disorders” and “mental illnesses” with each new edition and revision, to where it is now nearly a thousand pages. Though it is intended for mental health professionals, the DSM IV sold many, many more copies, mostly to laypeople, than there are mental health professionals in the world.
Ronson set out to interview and evaluate several people who were “notorious” criminals or well known high-flying and important business leaders and politicians in several countries to see how they fared when compared to the PCL-R. He also was able to visit the inside of the “hospitals” in the UK where diagnosed psychopathic criminals are held, literally “forever,” while they are being “treated” for their psychopathy after their criminal sentences are served out.
Ronson’s faith in the diagnostic ability of the mental health professionals was not strengthened when he studied the famous experiment by Dr. David Rosenhan and several others in the 1970s, who went to several mental hospitals and reported to the physicians there that they “heard voices” in their heads. This was the only abnormal symptom (or lie) that they presented to the professionals. They were admitted to the hospitals, where they never again acted “crazy” or lied to the staff. They behaved entirely normally. It was almost two months before they could “get out” by admitting that they were crazy and needed help. “There was only one way out. They had to agree with the psychiatrists that they were insane and then pretend to get better.”
Rosenhan’s experiment, once published, caused pandemonium in the mental health profession. One hospital challenged him to send in more fakes. Rosehan agreed. The hospital claimed it found 41 fakes the first month. The down side of their sleuthing, though, was that Rosenhan hadn’t sent any fakes to their hospital.
While no branch of medicine is totally objective, (they don’t call it the “practice” of medicine for nothing!) by its very nature, psychiatry is somewhat more subjective (in the eye of the beholder) than physical medicine. Ronson’s book does make the point, though, that putting labels on every behavior imaginable isn’t the answer to improving the practice, and neither is a pill for every disorder.
Psychiatry and pharmacology have both made vast improvements in the lives of many people who are truly mentally ill, but with poor diagnosis and poor medication, some great horrors have also been accomplished as well. Not every bad behavior means a person is psychopathic and not every bouncy kid is ADHD or bi-polar at age three. Ronson does make the point that mental health is a located on a continuum. No one is 100% mentally “healthy,” any more than no one is 100% physically “healthy.”
On the whole, I enjoyed the book, and he makes some great cases and writes in an interesting manner. The only criticism for his writing are the first couple of chapters “The Missing Part of the Puzzle Revealed”—and I’m not quite sure why they were included in this otherwise very interesting book. Maybe somehow I missed his sense of humor, but the rest of the book made up for the start I didn’t get.
I would recommend this book to anyone wanting to learn about abnormal versus normal psychology, and a bit about the “industry” that has grown up around “madness.”
The Psychopath Test on Amazon.com.