Psychiatry & Psychotherapy Podcast - The Dark Triad (Psychopathy, Narcissism, Machiavellianism), sexually violent predators, Ted Bundy, and porn.

Episode Date: February 6, 2019

On this week's episode of the podcast, I interview...quite a few people! We are covering Ted Bundy, America's most infamous serial killer, and since the world has been fascinated by him lately, I figured I'd get a group of mental health professionals in a room to talk about him. His horrific acts made the news and have scared people for decades now, and rightfully so. Did media and pornography cause this? What was his diagnosis and was it correct? We have so many questions... As my special guests and panel of experts, I invited Dr. Tony Angelo, who is head of services for a local prison and in charge of prisoners transitioning into normal life. I also invited Dr. Randy Stinnett, a clinical psychologist who co-manages an outpatient behavioral health department in a local community health clinic. Also with me is Nathan Hoyt and Adam Borecky, 4th year medical students who will be going into psychiatry. By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Welcome to the Psychiatry and Psychotherapy Podcast, the podcast to help you in your journey towards becoming a wise, empathic, genuine, and connected mental health professional. I'm your host, Dr. David Puter, a psychiatrist who splits his time practicing psychopharmacology, individual and group psychotherapy, medical director of a day treatment program, medical education research, and teaching, residents, and medical students. Welcome back to the podcast. Today we are joined by a group of people. you guys each want to introduce yourself so they can hear your name and your your voice. Sure. I'm Dr. Tony Angelo.

And Dr. Tony is a forensic psychologist who is the head of a group of outpatient, um, transitionary or permanent, you know, what happens with convicts when they get out of prison. Uh, he basically keeps them safe or keeps the public safe from them. and helps them in their journey as well. So is that a good summary of what you do?

Yeah, it is. It's mandated, primarily mandated treatment of high-risk sex offenders is the largest portion of our population. Okay, cool. And I'm Dr. Randy Stenet, also clinical psychologist, and I co-manage an outpatient behavioral health department in a local community health clinic here. And Dr. Stenet has been on two.

episodes, one on how to learn psychotherapy and another one on trauma. So Dr. Sennett, thanks for coming. Glad to be here. Hey, my name is Nathan Hoyd. I'm a fourth year med student going into psychiatry. And I'm Adam Berecki, also a fourth year med student going into psychiatry. Yeah, and so Nate has been on a rotation with me doing some digging for this episode. And Adam is a prior episode contributor on the cognitive distortion. So welcome, guys. And Adam has a background in ethics, so we're going to have him join in some ethics.

Good. Looking forward to it. We're going to be talking about this recent documentary on Ted Bundy. We're going to be talking about psychopathy, his diagnosis, going through facets of his life, things we can learn from the media exposure of him. You know, does pornography cause people, like Ted Bundy, we're going to talk about different aspects of his diagnosis, things that

were claimed diagnoses and why they were or were not that way. So here we go. So let's start by talking a little bit about your initial reactions of watching the documentary, watching the life of Ted Bundy. Randy, do you want to... Sure. I think the documentary is really well done. I actually didn't really know much about the details of the Ted Bundy, you know, whole situation of his criminal history, what he was doing. I had always heard the name, you know, growing up, Ted Bundy. I vaguely remember when he was executed and the whole piece with Jim Dobson. But I really learned a lot about his life and about sort of the fact.

I think what stood out to me, too, is how. Pathological his personality really was and I think particularly back in that time period Maybe difficult to really kind of pin down and understand really what was going on with him But I found it very very intriguing looking forward to the discussion Yeah and I'm wondering because you said it was it was well done or it was good. Yeah Was it pleasant to watch or was it enjoyable to watch? I Or was it interesting or how would you describe that? Yeah, it was interesting.

I found myself experiencing several different emotions and reactions while watching this all four episodes. A lot of anger, a lot of intrigue. It was uncomfortable at many points to watch, especially going into the details of his crime, all of his crimes. it was really fascinating for me to watch a lot of his mother's reaction and also the piece about the girlfriend and just so fascinating. But did I enjoy it and found it pleasurable? No. Tony, what were some of your initial reactions?

To be honest with you, well, it was kind of the completing of a circle for me. because I was aware of the Ted Bundy situation and actually a friend and I had made t-shirts during a period of time near his execution and I was in my early 20s at that point. A lot obviously has changed in my life since that point. And so going back and watching the documentary was really interesting, filling in a lot of the gaps like Randy was saying, where I didn't know as much about the story of what had happened. in the 70s as I thought I did. So there was a lot, it was fun for me to go back and in a sense fill in those gaps. But in terms of my reactions to it, it quite frankly was like a regular day

in a lot of my clinics interacting with our clients. We have a lot of folks who would fit a very similar profile. So I would say that for myself, it was kind of like, yep, that's what we regularly experience with people who have this personality profile. We're going to get more into that because that is both a disturbing comment. And yeah, can you say a little bit more about like what are some of the things that you see day in and day out that are similar? Sure. Yeah.

Primarily the attempts to manipulate with charming behavior. We see that all day every day. guys will come in who they are continuously attempting to wrap you around their finger. And everything is a setup. And we run training programs, forensic training programs with students and interns. And at the heart of the training that we do with them is reminding them, teaching them about the anatomy of a setup, as we call it. And the anatomy of the setup is really simple.

They'll treat you like their long-lossed friends. and all of that is designed to get something, just get you wrapped around their finger just enough, that when they need something, they'll try to pull that favor in. They're trying to hook you in, and they're going to turn it on you, though, at some point. They're going to try to manipulate you, have something on you, get you to do something. I've had, for example, students who have given guys rides places,

and that's a fast track to exit our program when we find something like that has happened. but the guys are great at getting that to happen. So just for some context, these people in your clinic are people that are coming out of the jail for violent crimes and sexual crimes. Yeah. Pedophilia. Serial rape, murder. Yeah, all the above. All kinds of violent and sexually violent crimes.

Yeah. Yeah. And you would think students, for example, who are coming into a training site like that, knowing that that's the case, would not be able to be talked into giving one of these guys a ride. So how does that happen? It happens because they're masters at manipulation. Almost everything they're doing is a manipulation and setting you up and trying to put you at ease so that they can gain something with you.

They can get you wrapped around their finger in some way. And also scoping on identifying who's the easiest to be manipulated. Totally. Who's got that vulnerability. Now, Randy, earlier you said, that what was surprising to you was that no one had dealt with this type of personality. And as I listened to you in that time period when he was alive. Well, I'm what I was observing, at least in, I was, my thoughts was specifically in regards to

what I observed on the documentary. It seemed like what Tony was saying was happening, you know, point after point with Ted Bundy. Is he, he came off charming. They described him as good looking. and he seemed to kind of pull in a lot of the people around him. I was thinking of the judge in the main trial, who seemed to have a kind of a fatherly quality toward him at times in terms of how he would speak to him.

And it's just that sense of almost, you know, magnetism in a sense for some people, that being pulled in into the manipulation. Yeah, and it's interesting because that's the very training that you're now doing, right? Right. So it's like we've seen this. It's different.

We understand it to some degree, right? And so part of this podcast episode, I really want to educate both professionals who may just interact with a few of these people once a year, you know, to the type of, you know, maybe the curious listener, the person who's interested in this stuff,

who's watching it, but not formally trained, you know, how they might understand and better recognize patterns, better see these things in other people, and have their guards up when they do see certain traits, certain patterns. Yeah. I think what we're going to get into, I think, a lot of the traits and qualities. The one thing that stood out to me when you were just talking now, Tony, is if there's one way in which these people view others, it's as total objects.

Yeah, pawns. I always say it. You're a pawn in their game. and they take, we often say repeatedly is that why do they do it? Because it's just what they do. It's just what they do. And so you would imagine, well, he has no reason to manipulate me. Well, he may not have a specific reason, but that individual, that's what they do. And that's why you have to continuously be aware that that is likely what is happening. And by that is what they do, it could be a component of they want control. They want power. They want, um, sex or some sort of power, sex, gratification, combination. And, um, I don't know, any other things jump, jump out at you. Well, I think that, um, you know, I like what you said that. That's just what they do. It's like dogs, bark, cats, meow. That's what they do in terms of manipulation. But the thought that

came to my mind, too, is it's almost that that's all they're able to do, right? If it's their full range. It's the full range of the repertoire. And from a phenomenological, you know, point of view, what's there in psychological capacity interpersonally? If all they can do is experience another person as an object and not have any, any capacity for empathy of your subjectivity, then all you are is an object to me. All you are is something for me to have as a pawn. If I could, too, I follow up to that by saying, because you're talking about educating

professionals. And one of the things that I see repeatedly as people are gaining experience in the forensic field is as a therapist who's inexperienced, I want to make a difference, right? I want to make an impact. I want to see people change. And so there's something that that becomes a fertile ground for this person to manipulate me as an inexperienced therapist because, well, I want to believe that I'm making a difference in your life. I want to believe that you're changing. And so when I see what seem to be all these pro-social behaviors and, you know, I had a trainee come up to me once and say, could I meet Mr. So-and-So at a coffee shop? We just want to discuss books because he's been telling me about his love of books. And I said, first of all, under no circumstance, I'm like,

if I hear that you have met him anywhere outside of this clinic, you'll be immediately. immediately dismissed because this is very dangerous and you have been set up and you're being manipulated. And this individual didn't believe that. Well, I could see it in her face that she didn't believe me. She didn't believe you. No. And she wanted to believe that she had done something that no one else could do, which was

reached this person. And one of the things, because I train residence, one of the big things that I try to do is I try to show them that not everyone thinks or feels like they do. Right. Especially a lot of therapists or empaths or people who are very sensitive emotionally who are listening to this, they have the hardest conception thinking of someone who has no affective empathy, meaning they cannot represent what is going on in your mind other than what they can see on your face or what they can see from your body language or what they

can hear from you. They can cognitively have empathy. but they can't effectively have empathy, meaning they can't feel into your experience. And for someone who feels into other people's experiences, that is like really hard to grasp. So if there's one thing that is the big takeaway early on, that will be it.

Okay. I want to get into, but first I want to hear from Adam. Adam, you watch this all in one day. You said it was too much. Yeah, yeah. Being the procrastinating med student that I am, I binged five hours of Ted Bundy documentary right before this session.

As you guys mentioned in your reactions, it's a little overwhelming. I identify Dr. Peter with one of the students that you guys were describing as very idealistic, somebody very, you know, wanting to do the right thing, wanting to, so I could almost see myself as a future psychiatrist getting sucked into the trap a little bit. And I've seen this already a little bit with substance abuse. patients here at the facility where Nate and I are trained, where, you know, they tell you everything, they've been through the ringer so many times that they tell you exactly what you want to hear. And it's, but they keep coming back. So you know that there's some, there's

something a little wrong. But specifically, David, what did you have in mind? I'm curious as an empath watching this. Was it hard for you to register that this guy probably doesn't have any empathy. I think so. I think that something you've talked a lot about in this podcast has been the motor mirror neuron experience, the ability of the mentalizing capacity that empathetic people have, right? So I kind of tacitly assume when I'm engaging in a therapeutic relationship or just to a conversation with somebody that what I'm perceiving them to be experiencing is really what they're experiencing. It's kind of an assumption that I think I have. So the capacity that what's going on in their head, like you guys mentioned, is not what's going on in my head

is kind of a foreign concept. Sometimes, okay, so someone who is antisocial, or not specifically the type of antisocial that's psychopathic. So we're talking about primary psychopathy. And this may be a lead into like why primary psychopathy is likely what he had. But someone who with primary psychopathy has low affective empathy. And so when you as an empath are listening to their story, you can, recreate in your mind an imaginative experience of what they're probably going through and evoke

emotion for what they should feel. But if you look at their face, their facial expressions are very different than what you would expect. Sometimes they're just completely blank, although they're telling a story that should be full of emotion. And if they do have emotion, it's often contempt or pride towards something that they did. And specifically, there was one scene, Nate, did you write, do you have the write-up of that, the one that I commented on? Yes. There was one scene in which he was on, he was on the media and so you could watch his face and it was actually a really good up-close facial, you know, image.

And so I was very curious to watch it and to see what micro-expressions he had because I read those kind of things. And specifically, in episode two at 4010, he says, A funny thing happened to me on the way to labor law class. I got two weeks in the spa on the labor floor here. Yes, I intend to be a good lawyer. I think things are going to work out. And when he was saying this, he had a very large, right-sided smile, which,

and his obicularis ocularestic, the facial eye muscles are contracted. And so he's in this smile, and it looks like an authentic smile, but it's a right-sided smile. So it's a contemptuous smile. It's a proud smile. But the micro-expressions that leaked out is a funny, and then you can see a flash of anger across his face. Thing happened to me on the way to labor law class. So he's in law school, and he got pulled away from law school. And so there's this thwartedness, you know, I got thwarted it.

I got two weeks in a spa on the labor floor here. he's trying to crack a joke, but then he flashes fear on his face, like a very quick up and together of his eyebrows. And he says, yes, I intend to be a good lawyer and then boom, down and together. So I intend to be a good lawyer. And then there's a thwartedness there that he feels. Like there's an obstacle. He's been caught, right? I think things are going to work out and then a flash of anger, or no, a flash of fear. And it was very subtle, very hard to see. and you'd have to really slow it down and watch it. And so what I noticed there was that anyone who's watching that probably just saw it as some sort of tick on his face almost or a normal sort of movement that you wouldn't even catch.

But what you were left with was this smiley face with a very large smile, which if you weren't looking at the right side of smile, you wouldn't see it as a contemptuous smile. So there you go. That was one little piece of like. incongruous. Incongruent speech. With adding in humor, right? There's like a playfulness part of it. And it's hard to think that someone who is playful could also be evil.

And what might also be noteworthy is that that whole quote came in the context of him talking to news cameras right after his first arrest. So he's in police custody at that point. That's also a very incongruent time to be playful and smiling so much. To add to that, though, he's in front of cameras,

which means he's on stage. He's got an audience. And that seemed to be somewhat of a theme for him where he derived gratification, going back to the trial. I mean, he was actor number one in that whole thing and took over the stage. And he seemed to get gratification

from doing that. But I think to your point, David, is even though he was, in a sense, kind of performing, the emotion was leaking out. The emotion was leaking out. The fear. The real fear and the anger.

Yeah. And the intense thwartedness. Because he got thwarted. Yeah. The anger, the rage was because his plans got thwarted. But even in the midst of his rage, it's so contained. Like, it's, it's,

he's able to play. the part, and there is that contemptuousness that is kind of the baseline, like pride, like confidence. If I could just ask a quick question to the psychologists here, you hear kind of like colloquially that psychopaths like Ted Bundy like don't experience fear in the same way that we do. So is there a disconnect between his expression, his flash of fear, or am I misunderstanding what psychopathy is? Well, I would say typically we would separate those two things. I guess we're jumping kind of to the...

Let's jump. Let's go ahead. Jumping into the born and the baked, you know, being the idea that I would say, and again, I don't have an exact number in front of me from the research, but just from my experience, that the majority of it is the baked, excuse me, are people get made that way. They get through extreme childhood abuse.

again in my clinics, you know, the guys that, and a lot of them are either diagnosed with antisocial personality disorder or at least features of it have just horrendous childhood stories. I never cease to be amazed. I always say our guys were certainly victims before they came, became perpetrators. And, you know, we could spend the rest of the time just talking about stories of these guys' childhoods that would make you just your hair stand on in. And it's terrible. So do they have a capacity for emotion? I would say, yes.

There is a, there tends to be a really latent rage that's under the surface and those guys that under the right set of circumstances does come out. And you can see extreme jealousy or extreme rage that's there. They've just become so calloused that they typically have that kind of underwrap. whereas the born psychopath, I think that's the one where, you know, one of the things we do regularly in our clinics as well is every guy takes at least one polygraph every year. And so, you know, with our guys who we would say are baked sociopaths, you still get an emotional response there. We do see the emotional response. It's there. It's just really truncated responses. They try to keep everything really tightly wrapped up.

where in rare exceptions, the born psychopath, we don't see much. There's not much happening, like even in a polygraph response. You just don't see much there. One other quick thing, too, that I would just note with polygraph, typically what we see is it may not be the results of the polygraph itself. It's what happens before or after polygraphs. Is guys become anxious about them, and due to their anxiety, they start revealing stuff to us. And so even people who have been diagnosed with antisocial personality disorder, so what we would be considering a baked psychopath, they still become anxious.

There is anxiety that is still there. That can cause them to then start revealing stuff they didn't intend to under that set of circumstances. Where again, born, not so much. Yeah, so I think it's, let's put out some definitions here because I think it's important. So when we talk about primary psychopath, this is something that Dr. Cummings and I have gone over sort of the genetics, the biology, and I think episode two or three. What did we do? What was cognitive distortions? Was that three? Those two. That was two. So in episode three, Dr. Cummings and I talked about primary psychopathy.

And primary psychopathy is really like low affective empathy. Not all primary psychopaths are criminals. And this can be difficult to understand. You could have a meta-structure of, I shouldn't do evil, I should behave according to the laws, I don't want to be thrown in jail, and I don't want God to throw me in hell. And you can be a primary psychopath and still follow the rules, but have no fear, have no empathy, and be pro-social. Now, it's about one-fourth in one study of people with this sort of low physiological arousal will be pro-social psychopaths, but you can still be pro-social.

So that's psychopaths. The second one is the sociopath, which is what we consider as like kind of a lay term is for someone who was baked into being antisocial. So this is a person who had a horrible childhood and then ended up sort of with these constellation of symptoms. And the third is kind of the DSM diagnosis. So this is the antisocial personality disorder. And it's the criminal psychopath or sociopath who is out there. you know, repetitive crimes, harm against others, low empathy, low connection with others. So let's talk about which one he probably was.

And when we talk, to answer your question as well, I would say the majority of what you see is not fear. The majority of what you see is not an impulsive anger in Ted Bundy. What you see is a very calculated predatory. predatory aggression. So in my previous episode with Dr. Cummings on violence, it was a recent one, we talked about the three different types of aggression. There's the psychotic aggression.

If you have someone with schizophrenia, that was not him. There is the impulsive aggression, which is someone who is, you know, gets really hot and heated and then do that, and then they react in aggression. And then there's the calculated predatorial cool aggression, which is, you know, it's a calculated predatorial, cool aggression, which is very thoughtful, very, it's got high frontal lobe activity. So there's a lot of planning involved. Yeah, I was going to say, just his jumping out the window shows you which one of those he was. He spent weeks prepping to jump out that window, right? Remember it talks about him just jumping off the bed so he could build his legs up to prepare for that jump out of the

courthouse. He took weeks in preparation for that one maneuver. Right. Right. That's, that's, that's That's a good example. Nate, take us through the DSM-5 antisocial personality disorder and how he kind of fit into that characteristic. Okay, so basically for the DSM-5 definition of antisocial, you have to be 18 years or older. You did have conduct disorder before age 15. Obviously, there's no schizophrenia or bipolar cause. And then there's this pervasive pattern of disregard for and also the violation of the rights

of others since the age of 15. So that's what you were talking about with the criminal manifestations of the psychopath. And then you have three or more of the following, and there's this laundry list of basically a constellation of behavioral features. So the first one is fail to conform to lawful behaviors, and you see this throughout his criminal career, obviously. But even before his criminal career, it's interesting to note that he's a lotful behavior. He was engaging in sort of like political espionage.

He was in the news for that even before he became a murderer. And also before, I don't know if you remember, when he would build tiger traps. So he was at camp and he would dig holes and he would put spikes in the holes with the hope of catching a tiger. Right? But lo and behold, a girl fell in and cut up her leg pretty bad. You know, so even as a young kid, that was for me. the biggest like aha moment when I heard that. You have planning. You have the desire to hurt someone else, an animal or a person, right? And the gratification once it happens. Right. Yeah.

Yeah. So that almost sounds a lot like conduct disorder features there when he was young. So then the next feature is deceitfulness. You see this obviously throughout most of his murders. they involve tricking someone into his car. In often cases, posing, for example, one time he posed like he had a broken arm in order to get help from someone. But you see it even before his criminal career early in his life in high school, one of his high school associates said, he tried to fool you and lie to you a lot. That was back in episode one. The next feature is impulsivity or failure to plan ahead.

while we have talked a lot about his really good planning, you do see a little bit of impulsivity where he, at one point, I think it's in episode two or three, a guard has an innocuous comment that they do, and then he gets riled, his teeth are barred, he's saying a lot of really angry things to the guard, so you see a little bit of impulsivity breakthrough there. And if I could too, I think we started to see him unravel at that whole Florida part of it too.

When he got, was on the run and now he's escaped and he knows the walls are closing in on him, he was fairly uncalculated what he did at Florida State University. I feel like he kind of just went almost on a rampage there. And that was pretty uncharacteristic, but things were unraveling for him, I think, at that point. Yeah. I thought it was interesting that he had not made any murders for a long period since he had escaped from Colorado. And when he got there, he did a series of murders there on campus and then one just a few blocks away. And it seemed kind of impulsive that you did something ago.

Irritability and aggressiveness. Of course, you see this throughout his life. Reckless disregard for the safety of others. So you mentioned the tiger traps as a kid. There's an instance in episode two where he repeatedly holds his girlfriend's head underwater. The next feature is irresponsibility. So you don't see this commented on a lot in the documentary, but he did miss Liz, his girlfriend at the time's daughter's baptism, something that they had planned for him to go to right after one of the murders.

And then the last feature there is lack of remorse. And I thought it was interesting in episode four. Toward the end, he says, I'm in the enviable position of not having to feel any guilt. So he ticks all the boxes there. He only needed three of those. One thing I'll say is that he claims to have heard voices that would tell him to do bad things.

And sometimes I do have schizophrenic patients, true schizophrenia, who they have voices that tell them to hurt others or so on and so forth. But the difference is that they have delusions that go with it. So they have a delusion that, for example, you know, this person is the devil. And then they have a command auditory hallucination of like, kill the devil, kill the devil, kill the devil and save the world. And then they kill the devil, right? But if they're caught in that, like soon after, they haven't covered their tracks.

they haven't tried to destroy evidence, they actually will be thinking that you will be rewarding them. So they'll be standing over the body, you know, without any sense that anything that they've done is wrong, right? With the psychotic patient, you'll have the cognitive impairments that go with the psychotic disorder. You often have the negative symptoms, right? So you'll have the affect,

affecting, blending, disorganized thought processes. Yes, yes. And with Ted Bundy, we didn't see any of that. of that. No. We didn't see any of that. And so I think when he says a voice told me to do something, I really believe it was like his own internal desires that were speaking loudly. You know, I don't think, I don't think he had any psychotic processes. It was too planned. It was too orchestrated. He covered his tracks so well. It was it was planned and planned and planned and planned, you know. Indeed. Yeah. I mean, if he says, oh, I heard, you know, voices were telling me,

well, is that simply just an echoic memory? Like I could conjure up the voice of my mother or somebody and hear it in my head. Or, you know, but is it a, is it the auditory hallucination of, you know, hearing that something as if it's coming from outside my ear, right? So that's the difference. Yeah. Do you, do you have any examples of this in your own practice, Tony? Well, they claim to be maybe psychotic, but you don't see it.

it or? Well, coming out of prison, I would say a high number of our guys have diagnoses of schizophrenia or bipolar. I mean, that's almost expected in their record, even though very rarely do we confirm that diagnosis. Most of the time, there are, you know, there's just elements of it that mirror some of that. And of course, this side note, but they're trying to get medication in prison anyway. Often they sell that medication. They have motivations for trying to some of that when they're incarcerated. But yeah, in fact, I really related to this idea. And I can't remember if the term used was the entity.

I think it was. He talked about the entity. That is a very common idea. Lots of guys who have antisocial personality disorder feel as though there is something else, almost an entity operating inside of them. And so that concept is fairly common. That's a fairly common experience. And it's not something that's a psychotic process.

Part of that is denial. It's denial of any responsibility. And it's an externalization of blame, right? We call it the MBDs, minimize blame and deny. Minimize blame and deny. You saw this toward the end of the documentary when Dr. Dobson interviewed him and he began to blame it on the pornography, right? And as a primary causal factor.

And so it's almost like, yeah, metamize, deferral, defy, deny, externalize the culpability, the agent of the crime. Yeah. And it seemed like Dobson was playing into that a little bit. Like that was Dobson's narrative.

Mm-hmm. What is the actual science there? We've done some digging. I had Nate doing some digging this week. Tony, you're an expert in this. So what is the science of, does pornography lead to pathology like this? So let me start by summarizing the findings, is that pornography is not viewed as a cause of sexual violence, but in persons who have preexisting, I guess I would call them a diathesis, or they already have the pre-existing, conditions for sexual violence, it's viewed as something that's a contributing factor. So predominantly the research is kind of moving in the direction of what's called the confluence

theory. And that basically states that men who kind of have a hyper-masculinity that involves psychopathic tendencies, low agreeableness, narcissism, early abuse, hostility towards women, and impersonal sexuality. And then the second part of that confluence is viewed as being sexual, basically sexual permissiveness, that they have attitudes about sex that are very impersonal. And so when you have a confluence of those two things, then pornography, especially violent pornography, that it could be things that involve rape, just, you know, things like that, that I think the research shows somewhere around 17% of people involved in kind of serial rape

have cited the use of violent pornography prior to that. So it's not really a large number. It's not as though we're looking at that and saying if somebody's viewing violent pornography, that will then lead to sexual violence. Not the case. It seems to be that the preconditions are already there. Whether there was pornography involved or not, these individuals are certainly the stage is set for them to act out.

on that. And one thing that comes to my mind to prove that point would be pornography has not been around for very long. And sexual violence against women, against men, has been going on since the beginning of time, right? Nate, what were some of the, what was the one statistic that we wanted to share about the violent pornography? Oh, okay. So Hald, Malamuth, and U.N. 2010 found, well, basically supporting what you just said, that violence and porn has been positively associated with attitude supporting violence against women. Yeah. But how strong was the association?

So it was found that the correlation between violent pornography and attitude supporting violence against women had an R of 0.24, and the P value was less than 0.001. and then the correlation between nonviolent pornography and attitude supporting violence against women, the R was 0.13. Yeah, so these are pretty, I mean, it's associated, but it's a very small association. So, no, I don't buy the Ted Bundy argument, which he later like disclaims, right? Like later on the tape, he said something. Yeah, in episode four at one hour, six minutes, and,

21 seconds, he says, I never said that it made me do it, speaking of the porn. I said that to get them to help me. I did it talking about the murders because I wanted to do it. Yeah. Well, and by the way, an interesting finding too in the research is that among individuals who have raped, they find greater arousal to rape porn than general population. So again, that is an indication kind of that people who are already predisposed to that find it arousing, but it's kind of a chicken and the egg question. And it certainly seems that it's the predisposition that's already there to it. And when they view that pornography, then they find it more acceptable and they find it arousing. So it's not going in the other direction that you take someone who does not have that predisposition,

and begin showing them rape porn, and then all of a sudden they're going to develop an affinity for it. That doesn't seem to be the direction that that works in. That being said, you know, media does influence us. You know, although it's not a huge influence, it does influence us. And to that we've been looking into as well. And one thing that comes to my mind is how frequently I see, even in music videos, how there's something sexual and then something violent,

like the second after. So often it's not sex and violence like at the same time, but it's like boom, boom, boom, boom, you know, something sexual, something violent, something sexual, something violent. And, you know, I think we have to think as a culture, how are we teaching young people about valuing women not to be objects,

not to be property? And the research is also showing that there is a greater influence of internet pornography than there is of traditional paper magazine type pornography as well. That's something that's concerning. Maybe it's because of the live imagery of internet pornography that we can actually see people engaging in the sex act in terms of, you know, it's video, it's live.

We're watching it happen rather than just looking at images, activating a different part of the brain. We're seeing structural changes actually taking place. Some of the research is indicating as well. Structural changes. Yeah, and I don't pretend to be an expert on that particular piece of it, but I do know that some research has shown that we're seeing there are appreciable changes in like gray matter in the brain and just the structure of the brain that it seems to be impacting different areas of the brain.

That's definitely an emerging area of research. Dr. Zimbardo from Stanford, who of course is famous for his prison studies, has been studying pornography recently, and some of his studies have been indicating some of the structural brain changes as well. One question I have to follow up on that is, let's say a guy starts with, you know, just kind of more basic porn. Can he slowly adapt and can he get, can he obtain pleasure from successive more violent and progress.

I have heard of some studies that talk about the sensitivity or desensitization process going on, that just in terms of needing, increasing the amount and the type because the brain desensitizes to whatever they started with. Yeah, it's equivalent to tolerance effects with drugs. Yeah. So interestingly enough, it's not always. that it transitions from one type of porn to another. Literally, we could do a whole episode on just this one piece of it.

I have some, what I at least consider, fascinating studies about, not studies, but examples of this guys, who started with typical, just what we would consider adult porn, who make their way into child pornography. And yet when we do PPGs, penoplethismograph on them, they're not pedophiles. So they make their way there because of these tolerance effects and that they need the next thing and then the next thing to, you know,

it's like using heroin. What used to get me high doesn't any longer, and they make their way through that process. That, however, isn't necessarily associated with hands-on offenses. Gotcha. And that's an important distinction that has to be made. I would say that's probably not the most typical route. I think most people end up, you know, if they're into typical adult porn, that's kind of where it stays.

But what we do know is there's also a satiation effect of that. It does become less potent to them sexually over time. So it loses some of its impact. And most people, though, don't make the transition into other kinds of porn. However, I'll set the stage for another episode, you know, things like midget porn, for example. I have guys who have gone from this to midget porn to amput. porn to bestiality porn

to child pornography. Things that most people probably don't even want to know actually exist. Yeah, thanks for that. Yeah, yeah. Try to unsee that. So, you know,

it doesn't though typically associate with hands-on offenses. Now, when you talk about this being interesting, what do you mean by that? I guess I'm revealing probably too much about myself

right now that I find this all interesting. I guess I'm jaded to it. is probably the truth. Just dealing with us so regularly. But yeah, I just find the human psyche so fascinating how, you know, if maybe that allows you to cope with it. Well, there's no doubt about that. It's like, it's like, like, because when I, when I've thought about you and your job,

because we've known each other for a while, I've thought, man, how do you do this day in and day out? Yeah. How do you do it? Yeah, you definitely put it in a box, that's for sure. And I would say we use a lot of camaraderie and supervision to, and we do. You know, I have a good friend who she is a psychologist now with the LAPD. And talk about how cops, for example, have a very strange sense of humor.

That's how they kind of deal with all the terrible stuff that they deal with every day. we have a strange sense of humor in our field as well, and I think it is the way we kind of, you know, ease the burden of that and in some ways, I guess, kind of make light of that. I imagine also at the core it's like you know that you're helping people. And the patient is not your patient, right? The patient is the community. It is. And actually, that's really interesting that you said that, because I do get this question fairly often.

How do you do that? and the hearing, especially because people imagine hearing the stories about children being offended against. And those are always difficult. But the answer, and it took me several years to really, I think, actually figure out my own motivation in this. But I did come to realize that, yes, I don't necessarily do this for the patient, because not all of them are going to make significant change. But I do it for, I realize most of them are fathers, right? There are children out there connected to them.

They have significant others. And if we can make relative changes that make recidivism less likely, then we've done a great thing for those kids and for those family members and the community at large. What would you say to the person that says, like, why don't we just lock people up who are high risk? Well, there's probably two answers to that. One, there are actually, we call those sexually violent predators, and they largely are locked up for life. So, you know, our state system really does identify the most dangerous and typically does keep them locked up for life. In less severe cases, we do now have parole for life is a possibility. So we can use what we call the containment model on those individuals for a lifetime, which is polygraph,

supervision and treatment. So we can view that as containing them in the middle of that triangle. But what most people don't realize when we talk about sexual offending is immediately most people's mind goes to child offenses. And really what we define as sexual offending is much, much broader than that. The child offending is a much smaller percentage of that broader category of sex offense. And so what we know is that the recidivism rate of sex crimes is actually some of the lowest recidivism rates when you compare it to general criminality. However, there are some specific subcategories of sexual offending that you, you know, would say

the recidivism rate is very high, and that would be amongst, for example, pedophiles, and people engaged in in things like flashing, things like that. That tends to be a rather compulsive behavior that becomes very repetitive. But in terms of, you know, the general category of sexual offending, the recidivism rate is actually quite low. And treatment is very effective, really, for those individuals. I have a question about that, too, because we and I've talked about that. And I worked for a time for you in the clinic. Is there a group of people for whom the treatment is more effective?

And I think group, I mean, like a diagnostic category of personality. personality pathology for whom the treatment will be more effective than others. It's like a CBT based treatment. It is. It's designed to be a CBT based. And yeah, I mean, I would say that it's a broad category of people who benefit from treatment, actually. I mean, when we talk about kind of the baked sociopath, as long as it's a matter of features of antisocial, person. disorder. Even those individuals benefit from treatment. And one of the things that we've come to

realize is that it doesn't, you know, I often say our clients will very rarely look like what we wish they would look like when they leave our clinics. You know, we wish that they, you know, would appear to be more mainstream members of society. That's not very realistic from where they're starting from, right? Most of them are coming to us. Their lives have really been broken. their emotional capacity has been fairly broken, but by being able to give them some benefit, right, by being able to help them understand how to be more intimate. And I don't mean that in a sexual sense. I just mean that in terms of how to make better connections with people,

how to have better attitudes towards authority, how to not use sex as a coping strategy, which is something that we see extremely common. Things like that, by making relative changes, those become very protective factors, and then the risk of sexual violence becomes less likely. That's really good. So, and with that type of person, that's the majority of your clinic, we're not talking about the Ted Bundy psychopath.

Exactly. The Ted Buddy psychopath needs to be put away for life, 100%. Yeah. Yeah, you've got to know where they're at. But is that based off of his actions? Like, hypothetically, we get to a place with our MRI or genetic, like, scanning. We knew he was the kind of person that would do this before he did anything. Would you still have the argument that, hey, we should put him away, given his predisposition,

or was that statement based solely upon what he actually did? What, based on the first murder, right? Someone commits the first murder, they need to, they need to be put away. And nowadays, you know, with DNA tests, with the U.S. has national databases, like, this guy would be caught a lot sooner, a lot sooner. Good. We're not good currently at predicting who is going to commit an act of violence, but once they have, we're really good at predicting who's really good at predicting who's going to commit an act of violence. So we're pretty good at recidivism, but I would not say we have any measures that are very valid for predicting who is going to. One thing you mentioned when we had coffee today was you said the hair prick test. Can you tell me a little bit about that?

Well, just was talking about the psychopathy checklist. Yeah, just as a means of identifying that cluster, that syndrome of individuals who meet those criteria. But like when the hair goes on the neck. Oh, I see what you're saying. Yeah, exactly. Actually, it was when... Stayed it the way you would stay. Yeah. How does it happen to you?

Yeah. Dr. Stennett and I were in grad school together. One of our professors, Dr. Sonny, actually, was teaching. I think it was in our MNPI class and so forth. Objective assessment. It was objective assessment. Yeah. She said, you can give all the testing you want, but one of the most valid tests of

psychopathy is the hair on the back of your neck test and that you just know it when you're in the presence of psychopathy. And that has proven to be very true to me through the years is I've become, I would say, fairly attuned that I can recognize the physical symptoms when I know I'm in the presence of someone who's just off in a way that alarms your body's natural. detection mechanisms and that you really can just kind of feel that. I remember meeting a client one time. I had no previous information and I went into my clinic and I had met this client and the hair on the back of my neck was telling me something is really, really off about this guy. When I finally got his file, this guy had been guilty of multiple charges of sexual violence

and murder. And he was, you know, he was killing what he would do is he would go to older women's homes who he knew to be single. And then he would offer to do like yard work and things for them. And then he would kill them, usually with a pillow. And so they were old. And so no one would really look into it as murder. It would be assumed that they had kind of died of natural causes and then he was raping them as well. Oh, man. And so he, he was, he was, you know, Here, again, the hair in the back of my neck was going off. And he was one of the guys, I would say, through the years, one of the most genuine psychopaths that I have interacted with.

There was absolutely, there was just nothing from this guy. The eyes were just dead. I mean, it was really alarming to be in his presence. Wow. This is also, you know, going back to then in the documentary, when Bundy was sent for assessment, psychiatric evaluation, and it came back bipolar disorder. Right.

And so it's like, what was going on? What were the diagnostic categories? What were the criteria? All of that, that ultimately that was the outcome of the assessment, that diagnosis of the assessment, rather than somebody, you know, the hair on the back of the neck or looking at everything that he had been charged with. and having that factor into the personality pathology.

When I heard that, I almost wondered like, okay, you're a lawyer who wants to get this guy off from the death penalty because you do not believe in the death penalty. And this is your passion. This is your life passion to get people off the death penalty to change that, right? So it's like, I'm going to find the one psychiatrist who will go along and sort of help me think that this is not just a moral deprivation, right? So, but was he bipolar, right? So the evidence that I would say that he's not

bipolar is most depressed people actually become less violent. And they're a little bit hypofrontal. Their frontal lobe is not working as well. So they're not planning. They're not orchestrating. They're not going to long lengths to get psychological needs met. Usually they don't even want to have sex. They don't have desire to do much at all. They're just lying in bed. So the whole idea that he was depressed in doing this, it doesn't make sense. You know, out of all the violent events that happen across the U.S., only about five percent of them are due to people with mental illness. There's like a pretty low rate, right?

So most of the violent acts, you know, gun shootings, stuff like that, are not done by people with mental illness. But even if we say, okay, well, maybe he did all of these criminal behaviors in a manic state. Right. So then I would say is every manic state ends in death, J. or psychiatric hospitalization. Exactly. This guy had no history of being hospitalized in a psychiatric hospital.

And he was only in jail when he got caught, right? Yeah. Well, this goes even, I think, into a side conversation perhaps of should we be categorizing antisocial personality disorder and psychopathy as a mental illness? This comes up every time there's a school shooting, a mass shooting of any kind. Yeah. And people say, well, it's, you know, he's mentally ill. And it's like, well, let's, you know, hold off.

off a second because there's a lot of people who are struggling with bona fide mental illness for whom this is an absolutely different universe with you know what we're talking about with ted bundy oh totally i was reading a american psychiatric association op-ed in response to the recent like parkland shooting and they were arguing that the call for improved mental health you know in a community health care is stigmatizing incredibly stigmatizing to those who actually have mental illness and it may even be irrelevant to the situation at hand absolutely it's just kind of a a grasping for control of some kind. Mental illness is just because antisocial personality disorders in the DSM does not mean

I would consider it a mental illness in the way that I would consider things like schizophrenia, bipolar, major depressive disorder, mental illness, because largely this is not something we treat. Like someone doesn't come to my clinic and say, I'm a psychopath, I'm a narcissist, you know, I'm Machiavellian, help me what medication would help. There's no medication. They're also not interested in help, typically, particularly if like the Ted Bundy type of personality. They want something from me. They want Xanax. They want Adderall. They want some medication that's going to help give them pleasure or get them out of this world. Exactly. The other piece that

you know, interests me too. I think we've kind of touched on it a bit is the nature of the crimes So there was a fusion of sorts with sexual gratification and violent murder. That was the nature of his crimes. And I think that's an important piece in the discussion too, is what about those particular crimes? Why did he gravitate toward them? Why were those gratifying and he was driven to engage in them? we have the evidence in his childhood, at least that documentary mentioned, of building the trap and the child falling in it. But there were a lot of different factors that led up to that.

There's one part where he talked about women. And he dehumanized women. Do you have the exact quote, Nate? Yeah, well, not more than that he said women are merchandise. It's toward the beginning of the first episode. And Tony, what would you call that in your... clinic when people have those types of phrases? Hostility towards women.

It's actually one of the primary categories that we evaluate when we're measuring the likelihood for recidivating in a sexual crime is the level of hostility towards women, and largely that is the objectification of women, viewing them as an object. And that's kind of almost on a continuum as to how they do that. You know, that can be increasing amounts of hostility and objectification. And that seems to be the only currency with which his personality had to interact with the world was objectification. Everybody was objectified. Everybody was upon.

Everybody was an object for him to manipulate in some form or fashion to get his way. I mean, from the sexually violent crimes to stealing cars to travel across the country. It's like everything was an opportunity for his objective gratification. One of my other arguments about why he didn't have mental illness is because when he was playing the part of being a normal citizen and even building himself up to be a normal citizen, he was doing things like joining a church, joining the Mormon church, being married, having... Being in politics. Being in politics. Having aspects of my life where I am normal and kind of protect my character in a sense. So someone with true mania, like everyone would know this person is manic.

They would be talking a lot. They would not be sleeping. They would be grandiose. It would be undeniable, particularly if you knew what you were looking at. Well, especially over the amount of time that we're talking about here, too, because it's not like this was on, you know, just a couple of weeks. We're talking about years that he's playing this role. So there's a large, you know, sample size there.

years, years and throughout other states. The other thing is like he, he had reason in the midst of these acts. So what I mean by that is like, he had the ability to cover his tracks. He had the ability to pretend to be not the person that he really was. Someone who's manic, it's like, you know, and when they come in and they're admitted,

this person cannot pretend to be anything but manic. They're talking, they're rambling. They have all sorts of delusions. You know, they're leaving their children in dangerous situations. And they're not, there's nothing calculated about it at, at the level that it ends up at. They've lost the capacity for conscious cognitive control over themselves in a sense. Right. Absolutely. Like they can't not speak as if they're on a motor driven by a motor.

Driven by a motor. They're talking, talk, talking. And they have all sorts of frames of reference. They're jumping. They're connecting things that are unconnectable. and anyone who watches that is like, what is going on? It's undeniable that there is some phase change that has happened to this person. Well, I'd like to set Nate up here maybe too or something he said before we started taping

was I think there's a need, though, on behalf of many to explain this behavior in some way that we can understand because otherwise it just seems really frightening. Yeah, you can see many times throughout the documentary how people described him as one of us. You know, he's a middle class person working his way up. He's a law student. He seems very friendly and charming. And there seemed to be a hesitancy for anyone to want to ascribe these sort of sinister intentions to him because then how could he be distinguishable from just a normal person like you, or me. When you said he was friendly or charming, did anything in particular bother you about that or anything come to your mind about that in particular? Well, there's a particular quote that I found very unnerving where someone, one of his friends from Washington State said that when he met him,

he was the kind of person you would want your sister to marry. That was. Yeah. That was unnerving. That's disturbing. It's especially disturbing from the 10,000 foot view of his life. life. But at that early moment of just meeting that person, meeting Ted Bundy for maybe a few minutes of, you know, or a couple hours of initial interaction, it's like, you might have that. But it's very unnerving at the big view that we experienced now watching, you know, his life unfold in those four episodes. The other thing I just want to quickly comment on, too, from what you've said is we also have to then interact with him differently. right? If we understand the personality pathology, we understand what's going on. On some level, I have to act differently with you. And I don't know how I might do that. Or like I was very intrigued again, going back to the judge in the trial and watching his mannerisms, watching how he interacted and wondering, how would I interact with Ted Bundy if I was the judge and he was representing himself in such a grandstanding fashion with.

all this manipulation, et cetera. Like how would I, how would I, even knowing what I do about, about personality pathology and things like that, how might I manage myself with him? You know, it's very interesting. I want to hit a couple other pieces of his diagnosis. One is narcissism. And so when we think about narcissism,

sometimes we have the low self-esteem narcissists. they're the ones who underneath the narcissism is like a deep woundedness, a deep desire to be mirrored because they weren't mirrored growing up. You know, Koha talked about these kind of narcissists. And then there's this kind of narcissist who is the high self-esteem psychopathic narcissist. What are some of the things that jumped out for narcissism when we looked at the DSM and looked at some of the things that came out in this documentary? So DSM-5 criteria state that there's a pervasive pattern of grandiosity, need for admiration,

lack of empathy, and this begins by early adulthood. And then there's a list of five or more behavioral features. So one of them is this grandiose sense of self-importance. They exaggerate their achievements. They wouldn't be recognized as superior, even though they don't have achievements to back that up. And you could see this at a number of different points. One of them is the situation you guys already mentioned where he says, I intend to become a damn good lawyer in the context of being arrested and interviewed.

There's nothing to back up that grandiose ambition there. And then in episode three, he makes the judge repeat his list of crimes so the court can hear. Here, he's gaining some sort of a grandiose sense of self-importance based on the achievements that he's done in sort of this twisted way. Next criteria is preoccupied with fantasies of unlimited success and power. So you can see some of his fantasies early on in episode one where he aspires to be affluent, recognized, looked up to. also in episode two he has an interesting thing that he says he says the eyewitness was non-existent I have to keep myself together and keep my presence of mind as long as I do I will beat these people he has this fantasy of unlimited success and by this point he's incarcerated in Colorado

this is kind of deep into his downfall and still he's dreaming of this unlimited success next criteria is special or unique and can only be understood by or associate with high status entities he emphasized repeatedly that diana and liz were both from wealthy backgrounds those are former girlfriends of his um he also like calls upon james dobson you know to kind of like be with him in his last hours before the death you know so there's kind of like this um looking for other people at the top of their dominance hierarchy to come to him to to associate with him to associate with yeah and he thereby also deriving importance through that association yeah yeah and the the next criteria is requiring excessive admiration um an interesting moment happens in episode two after one of the the first murders early on where he's with

Liz and he comments to Liz the next day about the news of his murder, it's pretty scary, isn't it? He also bragged about there being such a commotion about his escape from prison in Colorado. He paid attention to every time his own name was mentioned in media, so he's looking for this excessive admiration throughout all those things. And with that, he even like memorized people who were associated with the case, their faces. He greeted them when he passed them. So he really studied every aspect of his own sort of, you know, what was going on. Yeah. The next feature is this sense of entitlement. And there's an interesting thing that happens in episode two where he's angry that the Colorado guards are treating him just like everyone else,

like he was nothing special. They're also exploitative. And, well, you can see this through all the murders. He's exploiting these poor women for sexual release and for this adrenaline gets from killing. There's also this lack of empathy. That's the next feature. And we've already commented on that. Next feature is often envious of others and believes others envy him or her. And you see this.

He articulated jealousy both about Diane and Liz in episode one. And then this instance happens in Florida in episode four where he says that his attorneys are jealous of power so they won't let him participate in his own defense. So he's projecting that envy on them as well. And then the final feature is this arrogance and haughtiness. And we've already commented on him smirking in courtrooms during interviews. He was confident throughout that he could win, even with really heavy charges leveled against him. And, uh, well, if I could interject right there, too, it was interesting how that he didn't know what to do with that strategy didn't work when he, when the, you know, the kind of shmarmie,

grinning, I can make everybody laugh. I've got everybody doing what I want on command. When that wasn't working, he didn't have another tool in the toolbox. He didn't know what to do with that. And this really comes maybe to the next, the next piece of, the diagnosis, when looking at someone, I try to assess IQ level. And throughout the media is portraying him as like very intelligent. He's portraying himself as like super smart. You know, even like how people talk. He's like an evil genius, right? And yet as I like look at his life, there's like, I don't think this guy was that intelligent. There's no rocket scientist. Yeah. And so we there's a couple pieces of actual data.

that we can take to his IQ. Like, what is his IQ? Law school entrance exam. Yeah. Yeah. So one of the things we looked at was how correlated law school entrance exams are with IQ. Nate, what did we find with that? So one study was SESI in 1996, and they concluded that cognitive ability tends to be a good predictor of academic performance, citing specifically achievement tests like the L-SAT, GREA.

the SAT even, and saying that they correlate very highly with measures of cognitive ability like IQ. And so one of my thoughts is, you know, here he doesn't, he does pretty poorly on the LSAT. So he has to go to a school. It's like the first year that this law school is being established, which is like, you know, okay, you're not like in the top law school. You're probably in a bottom tier law school at this point. And then he's so, I think, dismayed by the law school that he transfers to another law school later on. because he didn't like being associated probably with that lowly law school.

Which is the narcissism piece. He had a narcissistic injury and had that rage reaction or a very intense reaction of being associated with something low. It violated his self-image. Yeah. Yeah, it's like he was helping Nixon and Nixon's run for president. and he was going into all of the anti-Nixon speeches and writing down notes, and he got caught, and he gets pulled into the front of the camera.

And he's like, oh, with this very contemptuous smile, you know, I don't think I was that important. This was actually, so it goes a step further. So this wasn't actually Nixon. It was somebody running for office there in Washington State. But he actually posed as an undergraduate student and got accepted onto the rival's team. and then was going through all the stump speeches

and conveying back notes to his own camp so they could know how to prepare their arguments ahead of time. So there's, okay, there's another level of sort of Machavelianism in there, right? Machavelianism is when you're thinking about strategy. You're thinking about how to beat someone. You're thinking about how to, you know, it's the competitive, but kind of the dark side of the competitiveness.

Nate, tell me a little bit about the definition of Machavelianism and how he might have related to that diagnosis. And so Machiavellianism, first of all, is not a DSM-5 diagnosis. It's kind of a concept that was come up with in 1970 by Christy and Geis. So basically, they developed this 20-question test called the Mach-4 test, that basically they extracted different themes from Machiavelli's writings and formed them into these 20 tests or 20 questions and tried to determine on a scale of 1 to 100 how much of Machaveli's ideas this person subscribed to. So this is not even a behavioral assessment.

This is mostly a worldview assessment of people. And so people, people. People who score greater than 60 on the Mach 4 are called high mocks, and they concluded that these people are more likely to deceive and manipulate others for their own personal gain. People who score less than 60 are low mocks and are more likely to display honesty and altruism. And tell me, were there any aspects of his behavior that kind of aligned with this? Oh, yeah, yeah, tons of it. So Machiavellianism kind of overlaps heavily with narcissism and also antisocial. And maybe we'll put, for the sake of time, we'll put some of our notes on my website,

and we will go through the time codes and why we think that the dark triad sort of relates to Ted Bundy and how you can understand it and the behaviors that are associated with it, so you can understand that further. still seems to be a piece that kind of becomes figural for me, and that is, especially with the high Machiavellian types as it dovetails with antisocial and narcissism, is what's the object relations here? How do I see, if I'm that person, another individual? Do I see them as an object? And if I see them as an object for, and if I'm kind of Machiavellian or strategic or even malevolent for my use or manipulation, do I see them that way because my neurologically, let's say, neuropsychologically, I'm incapable of representing their subjectivity. So is it a failure of empathy or all of the cognitive, neurocognitive capacities for empathy?

Therefore, that's my only option is to see the person that way. So in my empathy episode, I really go into this. But what they found is that Machiavellians will have normal empathy, both cognitive and affective, unless they also have traits of psychopathy. And a lot of them do have traits of psychopathy. But it's really the primary psychopathy that has the low empathy. So that's the driver for the low empathy, or at least the high score of Machavelianism, is the is the antisocial qualities i think i think someone can be macavelian who's who has normal

empathy i think actually empathy can help someone be a better macavelian person so they're really it's really a value statement yeah it's really like i value at the end of the day myself over everyone else and so i am very it's like a very political type of person who is maneuvering to try to get over on top of everyone else for the sake of themselves gotcha so Altruism is the opposite. You're trying to help other people. Parallel concepts that may have some overlapping, but really are parallel. Yeah.

Gotcha. What were you going to say, Tony? I was just kind of tying into that a bit, too. I think perhaps another of the distinctions between kind of primary psychopathy and the, you know, kind of the baked sociopath is they can have that empathy and concern for specific individuals in their lives, like maybe their child. or something like that who they would do anything for, where kind of the primary person,

there doesn't seem to be empathy capacity for anyone. So I think there's a distinction there as well. Yeah, I definitely see that. I see it with narcissists can sometimes love their offspring and almost have like a secondary narcissism from watching their offspring do well. And I think some of that's normal, of course. Of course we're proud when our children succeed. But what's different about it with this type of,

of behavior is that they can't have it almost outside of that. So it's like everyone else outside of their close circle of one or three people are like the outsiders who they have no empathy, no warmth, no. So one of the observations that I've made as well is that the kind of the homegrown psychopath doesn't necessarily have a need to be, uh, appreciated or valued by others. There's, there's almost a, I don't really care. I would like to be left alone in some cases even. I'm not really interested in the grand stage. I just want people to leave me alone because I can't stand humanity. I don't like people where what we see in a Bundy is we see actually this, this almost drive of those, I think to capture something, to experience

something. And maybe that's because it wasn't created. It's, that's just the way they came out of the womb this way and they're trying to capture something where the homegrown psychopath got made. He got injured and hurt all along the way and often really just wants to be left alone. Isolative. Isolated, yeah. This is a really good transition. And this will be kind of like the final topic before we conclude, I think, of the fact that he was so much in the media, how did that change future events in how people perceive things?

Are there copycats? How should the media perceive these types of people? Should they glamorize them? Should they be saying he's handsome, he's intelligent, you know, should they be showing the spectacle publicly? I think we've already seen the answer to that, right? Is Netflix had to come out and issue a statement saying, please stop calling Ted Bundy hot? Have you seen this? No.

Yeah, Netflix issued a statement on their official Twitter account saying there are many people on Netflix who are hot and also didn't kill a bunch of people. Please stop calling Ted Bundy hot because this is now sweeping the world. People who are just getting exposed to Ted Bundy for the first time are saying, oh, he was hot, he was whatever. And Netflix was actually disturbed to the point they issued a statement about that. So I think we kind of have the answer to that already is these people do in some way appear glamorized to certain people.

And I was looking at Twitter as well and sort of seeing what people were saying. And a lot of people were like in episode one. And they're like, I don't think he did it. And then they're, they tweeted out later. Oh, I get it. Never mind. So maybe in episode one, they think he's hot. And maybe in episode four, they think maybe I'm kind of happy this guy died.

I want Nate to kind of share some of the things that we were digging into. in regards to media and how media influences and potentially how this can be influential going forward. Like let's say people in media were listening to this or people were thinking about how they were going to report on stuff like this in the future. How should we think through it? So Nate. Yeah.

So we were reading from this book called Influence Science and Practice by Robert Caldini. There's a really interesting chapter in there on social. social influence. And there's a concept that's explored called social proof that basically says that we determine what is correct by finding out what other people think is correct. And it goes on to be applied in ways like if someone is unsure, especially if they're unsure of what to do next, they look to what other people are doing, other similar people specifically. Now, a very simple example of this concept, just so you can understand it, is when, for example, a bartender or a restaurant has a tip jar, they'll leave a few dollars in there to make it look like other people are tipping,

and that will encourage you to tip. So that's like a very simple example of this. But unfortunately, there are much deeper and more sinister examples of this. There's something called the Werther effect where Goethe published this book, this is more than 200 years ago in Europe called the, well, basically the translation is something like the sadnesses of Werther. Wither is this hero who ends up committing suicide. And they found after this that there were a bunch of copycat suicides through Europe after the publishing of this. So that's where they got this idea, effect. Phillips in 1974 explored a modern Werther effect where two months after a front-page suicide story happened, he found that on average, 58 more people than usual

committed suicide specifically in the area where the story got the most publicity. And a later study in 1983 took this further into the realm of copycat murders so that when there was a murder that was publicized heavily, there tended to be a rise, a significant rise in similar murders, even of individuals of similar demographic, in that geographic area. And there's a quote from the book that I thought was pretty, went along with what we were talking about. It says, such reports are not only riveting, sensational, and newsworthy, and I'll break there just to

to say that sensationalism, especially in this era where print media is struggling, even some digital media is struggling, sensationalism sells a lot, and so they end up focusing on that in order to get better ratings and sell more. Not only are these stories riveting, sensational and newsworthy, they're malignant, is what the book says. One thing that we were talking about before we started was it's really bidirectional. People are interested in the abnormal, in those in those really rare freaky cases. And the fear of it is, is this a new fear? Is this a concern that I need to be afraid of, that I need to be on guard of? You know, is this how I'm going to die? Is this how my kids are going to die? And often it gets

overblown to the point that we forget about, you know, most people die of heart disease. Most people die of smoking, alcohol, bad dietary issues, car accidents. Most people do not die of this type of thing. But with the betrayal of media and how it gets magnified and magnified, it becomes like how people think people die, you know? And that fear there gets sort of drives the consumer, the people who listen to this to, you know, watch this kind of thing. And then the news notices that you're watching it. And so then they want to show it. Yeah, I was going to say that that's like the likelihood that your child is going to be sexually offended against by a stranger is almost nil. It's almost always going to be someone known to the child, family member or family friend.

So we really talk about it's the myth of stranger danger, and yet that's what most people are afraid of for their child, is that a stranger is going to abduct their child or sexually offend against their child when that's almost unlikely to happen. How rare is it? Like under like around 1% 1% of what? Of sexual offenses against children. Are strangers.

Yeah. Yeah. Most is that weird relative, that weird friend? Well, no, no. And I wouldn't say weird. Okay. Okay. That's the, that in a sense is you often don't expect that it's going to be that

individual. A lot of times it might be, you know, a young girl gets left with, someone's teenage son and he out of a curiosity, you know, ends up doing something sexual to the child, right? Or it's an uncle or it's a friend and the offending is worse, but it's not very predictable. You typically can't predict like, oh, that guy's kind of weird, he's likely going to offend. That's maybe what is a little bit frightening about it, is that you really can't just look at somebody and know that. But it's not likely to be a stranger.

What may drive the fear of the stranger situation too is perhaps the evolutionary phenomenon that we consider that which is not inside the tribe or inside, you know, that which is not kin to be default dangerous. Yeah. And then magnified with the horror of sexual offense. Yeah. And I think that the reason I addressed that was specifically because what does the media love to promote. They like to promote when a child is abducted, right? And that's what,

you know, that always gets team coverage on the evening news. And so that's what is now salient in people's mind is this idea that, oh my gosh, my child is going to get abducted. And I have to watch everything that they do. And it has had consequences, I think, in how we raise children because our kids now are so often so overprotected that there have been consequences to that. And I think a lot of that has kind of fallen at the feed of the media. The media promotes this idea because it is salacious and it does get people's eyes on the set to watch that when it is really statistically almost an anomaly. And which increases their revenues, which ultimately is perhaps the primary driver. Yeah, and we were also talking about like what do people view, you know, in movies?

What do people view on Instagram? And the things that people view and want to view, more will be created. And so there is a bidirectional thing, especially with social media. Like a lot of social media has become, you know, attractive people, feats of strength, beautiful things, beautiful pictures, right? And those are the things that get more likes and things that get more likes get more likes get more people creating similar things. And so there's this kind of like bidirectionality of how the culture creates the sort of

the id, the underlying, you know, drives are then manifested in the media, in the social media. And it's bidirectional. Especially if the media technology itself is infused with monetization. Like if you can get your YouTube or your social media videos monetized, yeah, more of that will be created because it gets more, you know, butts in the seats to view it, so to speak. Yeah. And, you know, you have to give it to YouTube to demonetize people who are hurting

themselves to give views. I mean, that's probably a good move on YouTube. Adam, I wanted you to talk a little bit about your thoughts on media, on the ethics of it? Yeah. No, I think you guys really hit all the points I was going to say anyway. Just regarding this conflict of like motives regarding the monetization of and then as well as kind of playing on our psychology, like what do we find emotionally salient?

What's going to stick out to us? And so we kind of are gravitated towards that and we keep feeding the machine. And then the machine is going to keep giving us people like the mass shooters that we're seeing in high school. right now. And a concern that I have, I was going to ask Nate about this, was, ethically speaking, should the media kind of almost self-censor aspects of these mass shootings, should they, in order to dissuade potential copycats? So I don't know if you found any research on that, Nate, or if that's anything you've thought about. One of my general

thoughts is maybe if they have something that they once said, you know, so they're, I I'm going to shoot up a school because I want my journal read and because I am, you know, I want my ideas put out there. Maybe we shouldn't put out their ideas. Maybe we shouldn't put out their face, put out their name. Maybe we should focus on the heroes. And maybe we should focus on the people who, like, attacked back, you know, and kind of idealized those people.

Yeah. I was kind of worried that the fact that we're talking about Ted Bundy, the fact that there's a whole Netflix thing about Ted Bundy, if Ted Bundy would happen to, you know, still be alive, would he just be kind of giving us that smirk. Like, this is exactly what Ted Bundy would have wanted, right? Are we, and are we at risk just because of the fanfare? Are we at risk of creating more Ted Bundy's? I'm not sure if you have any thoughts.

Well, I'm not sure Ted Bundy was created. Okay, okay. In a sense of like being the baked variety, you know, per se. And this goes back to what we talked about too. I think, and I was wanting to bring up and we don't have time to fully just explore it. but it was, I didn't hear a lot about a horribly traumatic childhood in the documentary. That was the worst part was that it was painfully normal, like Washington, Tacoma, middle class, church, a mother that was like seemingly warm, nice neighborhood.

Although it seemed to be a bit pathological herself toward the end of it, right? Well, she really believed that this couldn't be my son. And when she found out, it said she whimpered. And that scene at the end, that, picture, photograph where she's kind of on the floor with her head, on the leg of her husband. It was just, that was heartbreaking. Yeah. But, you know, maybe the, you know, maybe the documentary did not include all the salient, you know, trigger moment events of his childhood that would predispose him to this.

But you would think that if they were known or that happened, that would have definitely been included. I didn't hear a whole lot about a terribly traumatic childhood. So it begins to beg the question, did he come into this world? As a, as the, all of that pathology and criminality was that latent in his arrival into this planet? And then moments for expression and the right environmental situations. Therefore, he became the Ted Bundy that we watched in the documentary. So maybe there will be, what you're saying is maybe there will be Ted Bundy's out there, whether we like it or not, and maybe are discussing it, could have the beneficial consequence

of kind of preparing us, almost like a vaccine in a sense. We know that they're out there. I think maybe it's a little like our porn discussion is the predisposition's already there. Maybe the attention feeds the fire, but not the primary motivation. Sure. Yeah. It's not going to create more Ted Bundy's to make the documentaries or all the books or other documentaries that, you know, were made prior to this one or even our discussion.

Right. I think there's going to be that one in a million person that is extremely altruistic, the mother Teresa, you know, and then there's going to be that one in the million person who is that evil person who has a ton of gifts and who uses all his gifts to gratify his own desires. to dehumanize other people and to inevitably, you know, hopefully get caught and put away for life. You know, it does, I think, speak to the point that there is so much that is temperament in who we are and our personality and, you know, what we gravitate towards as well. And this is by no means a finished or concluded area of research. But in a lot of the attachment research, you had individuals coming along and saying, you know what? The data typically shows that the vast majority of our personality is temperament. Well, and this, I would say, like, is he not responsible because of how he was genetically wired?

And I would say a lot of genetics is actually epigenetics. You make decisions, you make choices, and you actually rewire your brain. over time depending on those decisions and choices. And so if, you know, a psychopath, a person who's got primary psychopathy can go one or the other way, they can be either incredibly helpful to society, bomb diffusers, you know, people who do high-risk jobs, who need less fear, who need less empathy to do those jobs well to help society move forward. And they could also go the opposite way.

Yes, yes. You know, so I would, some of my patients who tell me that they had no choice to hit their wife, I say to them, well, then why didn't you kill her? And they, they look at me like very surprised, and they say, well, because I didn't want to go to jail. And I'm like, see, you have control. You did not, you did not black out because you decided when you would stop. Yeah. And so at the very peak of your aggressive act, you still have control. And just that knowledge, in their own brain actually helps them. When they get to that decision point next time,

and they remember me saying this, and they remember me saying, like, look, you're going to walk out the door instead or your wife is going to call the police. And that kind of dynamic, it's like, okay, I have more choice than I'm giving myself in my mind. I think this is an extremely salient point because we typically bifurcate it

with free will versus predestination kind of a thing. but the middle ground point in that is determinism versus free will. Yeah. Is the choice point. Right. And you go to prison for the choices you made, not for the psychological predisposition you may have at the time.

Sure. That's a different question altogether from insanity and incompetence, but choice is the key. And also to that, I would say, there's been studies where they have people read something that is pro-determinism. So they read a paragraph that kind of is trying to say that everything is genetics and you don't really have choices. And your every cause is due to things that are happening to you.

And those people then go into economic games and compare to the people who didn't read that, they cheat more, they lie more. They have less frontal loat function. And so psychologically, what happens to someone when they start believing that things are determined is that they can externalize the blame of their own choices onto other things other than themselves. So I think it's very important psychologically and in the media and how we portray these things to show that actually people do have choice.

And there is another dimension here, the moral dimension. Yes. And with that comes responsibility. If I have choice, I have responsibility. And it's responsibility to society as well, to other people, to other humans. And so I think that's the key too. That means that there are people who have less choice than others. And one way to illustrate this is if you are on NyQuil, on alcohol, and your eight drinks in,

you probably have less choice over what your next decision is, decision is. You know, you're more reactive, right? And in the same way, someone with a very bad frontal lobe injury will have less choice, frontal lobe dementia. And so Dr. Cummings will say, like, look, we have to lock up people who are dangerous to society, period. Like if they make the choices that lead them that direction, regardless of their genes, the most safe place to put some of these people would be in jail forever. And this is where I think the responsibility piece becomes figural is that the person with dementia or a psychiatric disorder that rendered them incapable of or incompetent in a sense, that's different from somebody who took the drinks. prior and then made themselves vulnerable.

So it goes back to choice, but choice has to be fully in line with responsibility. The choice that you made may be to take the first drink. That's right. And you're responsible for that choice. And you're responsible for everything that comes after us. Correct. Because when you took the, when you made the first choice, you were fully in control. And as you go further into drinking, you have less frontal lobe function.

That's right. So, but no one would argue in a court of law that what happens after that is not their fault. Correct. And so if you have the predisposition to being angry when you're drinking, you should not drink. Yes. If you get paranoid and angry when you smoke weed, you should probably not smoke weed and, you know, so on and so forth. And you have the capacity to make that choice. Right.

Yeah. Tony, it looks like you have something to say. Are you? No, I was enjoying that piece of the discussion. I thought that was actually quite good. And I was just thinking in terms of that that is at the heart of a lot of what we do teach in our group setting. is that the idea of locus of control, that, you know, is it an internal locus of control? You are the one making decisions rather than the world is happening to you,

because that certainly is a very prevalent psychological set amongst criminals and offenders, is that the world has happened to me rather than the locus of control is internal to me, and I'm the one making these decisions. Bundy tried to tempt people to, I think, to believe that about him, again, going back to the pornography discussion. Yeah. And we want to, I think the worst part is I found myself wanting to believe him because I don't want to believe that like somebody could do the things that he did, like by choice.

I almost would rather there be some brain tumor discovered or something in Bundy. I don't know. Do you guys have a similar reaction? Yeah. And I think I think I just want to quickly tie this back to our. discussion earlier about therapists or clinicians in training, we don't like the feeling of having to be calculated in our interactions with someone like that, even in a clinical setting. Because you have to be extra on guard with this kind of patient.

Yeah, you're talking about this. Yeah, you're basically playing a chess match often when we're dealing with these folks because I am, I'm evaluating everything they're saying. where are we going and what are we doing? There is a bit of a chess match, you know, that's going on. And there's a different quality to that evaluation than I would have evaluating a patient who I don't right away get a sense or know ahead of time has this kind of personality pathology.

You know, you're much more relaxed. Your empathic mechanisms and qualities are much more open and less, you're less vigilant, you know, in that moment. We don't like those of us who don't go into forensic work. Let's say don't like having to the idea of being in that in that mode when you're with a patient. And so it's hard to think that you would have to. Right.

I think I kind of want to end with Tony talking a little bit about specifically the treatment side and specifically how do you help someone change their mindset from how they, how they view women from being objects to being not? And how do you help them gain a sense of they can have intimacy and not just objectify people? Yeah. So it really does start, you know, one of the things that we typically get to is we get a large criminal history.

So thankfully, because we're not entirely dependent on self-report. So we get a police reports, we get things like that that really do depict for us what this individual has actually done. We strategically will use that in the treatment as we're going along to say, well, yeah, but I happen to know these circumstances occurred. Well, what about this? Because they'll try to craft an image of things that is, you know, well, the world happened to me, like I was talking about Locust of Control.

Well, I don't even know why I'm here. So it's kind of starting out there. You do want to work and you build some rapport. kind of get something in the bank with them, but you're also armed with this information of knowing what they have done and what they're capable of. And so there's a little bit that of going back into that and saying, look, you know, what you have done is the past is prologue, if you will. You're very likely going to continue this cycle of behavior if we don't do something. So we start with a module on change usually and talk about the importance of change itself and how change

occurs and that if you don't, you're going to just keep getting what you've always gotten. You're going to continue this cycle of in and out of prison. And if that's what you want in your life, then there's nothing I can do about that for you. But if you want something different, if you're ready for change and you're ready to take an honest look at these things, then we move into largely what are dynamic risk factors that's kind of prevalent in the field right now. Dynamic, and those are referred to as the stable factors, meaning that they are stable. They're largely stable, but they are changeable. And those are things like issues with authority, intimacy deficits, hostility towards women,

things like that. So we then begin to target those different aspects kind of one by one and just kind of going through that treatment with them of saying, let's talk about your relationships with women in the past. And we just dig into that. And so kind of piece by piece, we start to go through each of those different dynamic factors and basically see what we can accomplish in each of those areas. Again, with improvement in each of those areas, their recidivism risk drops pretty appreciably. Yeah, that's good. That's good. And I think we'll have to do another episode in the future on specifically the therapy towards that, because that is something that is a little bit more nuanced and probably a little bit different than the normal therapy we would give. But I think also

very important because, you know, we get these patients, right, who are unhappy with their lives, but they may have traits of narcissism, of psychopathy, of, you know, and these traits are leading to this very deep unhappiness or multiple failed relationships. And so it's like, what do we do? How do we approach it? So thinking about authority, how they view authority, thinking about how they view intimacy, how they view connection with others. I think those are all very important. Okay, well, I think we're going to leave it there, unless anyone has something on the tip of their tongue.

Okay, we'll leave it there. We'll have a write-up that will go with this with details, more details probably that are in this episode. We'll have links to the different scientific articles that we talked about or some of them. And if you want to get CME for this, you can sign up for the CME subscribers, description. And yeah, please join the conversation. If you have any questions, thoughts,

uh, you know, shoot me an Instagram message or post a comment on my Instagram that links to this episode. And we can continue the conversation. I am having a follow up with Dr. Cummings on violence. So if you have any questions on violence, please continue to email me those at D.R at psychiatrypodcast.com. And until the next episode, have a great time. Thank you for listening. And I hope you found this as interesting and engaging and disturbing and all those things as I did. Take care.