The Psychopathic Patient - A Case Study

Therapy session notes provide insight into living with Antisocial Personality Disorder (AsPD) - psychopaths and sociopaths.

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Notes of first therapy session with Ani Korban, male, 46, diagnosed with Antisocial Personality Disorder (AsPD), or Psychopathy and Sociopathy

Ani was referred to therapy by the court, as part of a rehabilitation program. He is serving time in prison, having been convicted of grand fraud. The scam perpetrated by him involved hundreds of retired men and women in a dozen states over a period of three years. All his victims lost their life savings and suffered grievous and life-threatening stress symptoms.

He seems rather peeved at having to attend the sessions but tries to hide his displeasure by claiming to be eager to "heal, reform himself and get reintegrated into normative society". When I ask him how does he feel about the fact that three of his victims died of heart attacks as a direct result of his misdeeds, he barely suppresses an urge to laugh out loud and then denies any responsibility: his "clients" were adults who knew what they were doing and had the deal he was working on gone well, they would all have become "filthy rich." He then goes on the attack: aren't psychiatrists supposed to be impartial? He complains that I sound exactly like the "vicious and self-promoting low-brow" prosecutor at his trial.

He looks completely puzzled and disdainful when I ask him why he did what he did. "For the money, of course" - he blurts out impatiently and then recomposes himself: "Had this panned out, these guys would have had a great retirement, far better than their meager and laughable pensions could provide." Can he describe his typical "customer"? Of course he can - he is nothing if not thorough. He provides me with a litany of detailed demographics. No, I say - I am interested to know about their wishes, hopes, needs, fears, backgrounds, families, emotions. He is stumped for a moment: "Why would I want to know these data? It's not like I was their bloody grandson, or something!"

Ani is contemptuous towards the "meek and weak". Life is hostile, one long cruel battle, no holds barred. Only the fittest survive. Is he one of the fittest? He shows signs of unease and contrition but soon I find out that he merely regrets having been caught. It depresses him to face incontrovertible proof that he is not as intellectually superior to others as he had always believed himself to be.

Is he a man of his word? Yes, but sometimes circumstances conspire to prevent one from fulfilling one's obligations. Is he referring to moral or to contractual obligations? Contracts he believes in because they represent a confluence of the self-interests of the contracting parties. Morality is another thing altogether: it was invented by the strong to emasculate and enslave the masses. So, is he immoral by choice? Not immoral, he grins, just amoral.

How does he choose his business partners? They have to be alert, super-intelligent, willing to take risks, inventive, and well-connected. "Under different circumstance, you and I would have been a great team" - he promises me as I, his psychiatrist, am definitely "one of the most astute and erudite persons he has ever met." I thank him and he immediately asks for a favor: could I recommend to the prison authorities to allow him to have free access to the public pay phone? He can't run his businesses with a single daily time-limited call and this is "adversely affecting the lives and investments of many poor people." When I decline to do his bidding, he sulks, clearly consumed by barely suppressed rage.

How is he adapting to being incarcerated? He is not because there is no need to. He is going to win his appeal. The case against him was flimsy, tainted, and dubious. What if he fails? He doesn't believe in "premature planning". "One day at a time is my motto." - he says smugly - "The world is so unpredictable that it is by far better to improvise."

He seems disappointed with our first session. When I ask him what his expectations were, he shrugs: "Frankly, doctor, talking about scams, I don't believe in this psycho-babble of yours. But I was hoping to be able finally communicate my needs and wishes to someone who would appreciate them and lend me a hand here." His greatest need, I suggest, is to accept and admit that he erred and to feel remorse. This strikes him as very funny and the encounter ends as it had begun: with him deriding his victims.

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

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