Jeffrey Dahmer and Autism Spectrum Disorders

International Journal of Offender Therapy and Comparative Criminology http://ijo.sagepub.com/

The Dangers of Posthumous Diagnoses and the Unintended Consequences of Facile Associations: Jeffrey Dahmer and Autism Spectrum Disorders Mark T. Palermo and Stefan Bogaerts Int J Offender Ther Comp Criminol published online 10 September 2014 DOI: 10.1177/0306624X14550642 The online version of this article can be found at: http://ijo.sagepub.com/content/early/2014/09/09/0306624X14550642

Published by: http://www.sagepublications.com

Additional services and information for International Journal of Offender Therapy and Comparative Criminology can be found at: Email Alerts: http://ijo.sagepub.com/cgi/alerts Subscriptions: http://ijo.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://ijo.sagepub.com/content/early/2014/09/09/0306624X14550642.refs.html

>> OnlineFirst Version of Record - Sep 10, 2014 What is This?

Downloaded from ijo.sagepub.com at Tilburg University on September 10, 2014

550642

research-article2014

IJOXXX10.1177/0306624X14550642International Journal of Offender Therapy and Comparative CriminologyPalermo and Bogaerts

Article

The Dangers of Posthumous Diagnoses and the Unintended Consequences of Facile Associations: Jeffrey Dahmer and Autism Spectrum Disorders

International Journal of Offender Therapy and Comparative Criminology 1–16 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0306624X14550642 ijo.sagepub.com

Mark T. Palermo1,2 and Stefan Bogaerts3,4

Abstract Posthumous diagnoses are not uncommonly given to notorious public and historical figures by applying retrospectively, and typically in the absence of the individual being diagnosed, contemporary diagnostic criteria. Although this may be relatively easy and free of consequences when it concerns clear-cut medical conditions, it may have unintended repercussions in the case of psychiatric disorders by creating myths and perpetuating stigma. The case of serial killer Jeffrey Dahmer is a typical example where a somewhat facile and almost syllogistic application of perhaps over-inclusive criteria may have contributed to the legend of solitary murderers as possibly suffering from an autism spectrum condition. Although there may be an understandable human need to explain abominable and heinous behaviors, the lack of the possibility to verify a diagnostic theory and the ill-advised attempt to make a diagnosis fit may de facto be the basis of prejudice and profiling that do not correspond to clinical reality. Although there is no doubt that the brain is the organ of behavior, the authors caution against a budding neo-Lombrosian approach to crime and criminality and against the all too common use of widely differing terms in the study of deviance, such as crime, delinquency, and aggression, the operational use of which, often used interchangeably even in association studies, often erroneously leads to further confusion.

1Medical

College of Wisconsin, Milwaukee, USA Law and Behavior Foundation, Amsterdam, The Netherlands 3Tilburg University, The Netherlands 4Forensic Psychiatric Centre de Kijvelanden, Rotterdam, The Netherlands 2The

Corresponding Author: Mark T. Palermo, Via Capo le Case 3, 00187 Rome, Italy. Email: [email protected]


2

International Journal of Offender Therapy and Comparative Criminology

Keywords Asperger syndrome, serial killers, autism spectrum disorders

Introduction Posthumous diagnoses, although controversial (Karenberg, 2009; Muramoto, 2014), are not uncommon in medicine and a posteriori clinical explanations of complex behaviors are often given in an attempt to shed light on famous or infamous individuals, events, or historical periods that might otherwise bewilder witnesses or survivors because of their monstrosity. In addition, psychological or psychiatric explanations of heinous behaviors may be one way to circumscribe a socially or morally unacceptable action and, in relegating it to a medical and psychological realm, attempt to control it (Fromm, 1973). This has been attempted most notoriously with prominent historical villains, such as Adolf Hitler (Rosenbaum, 1999), but psychological investigations of the minds of more or less well-known deviant individuals abound and seem to be very attractive to the general public. Although contemporary psychiatric nosology claims to rely on rigorous definitions resulting from the objective application of scientifically based standards, the apparent ease in applying diagnostic criteria to observable behaviors not uncommonly can result in over-diagnosis (Bolton, 2013). This has most certainly been the case in the field of developmental psychiatry where, following the introduction of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association [APA], 1994), only recently replaced with the new fifth edition of the DSM (DSM-5; APA, 2013), we have witnessed not just a sudden rise in the prevalence of a number of disorders but also, for some, an actual apparent epidemic, such as in the case of Asperger syndrome (AS), attention deficit and hyperactivity disorder (ADHD), and childhood bipolar disorder (Frances & Batstra, 2013). Unfortunately, in fact, in the mental health arena, it is not uncommon that complex behaviors are simplistically and erroneously labeled by using a checklist approach, which appears, at a superficial glance, to be connected to the way contemporary psychiatric diagnoses are thought to be made (McHugh & Slavney, 2012), or, possibly, actually are made. Common sense, sound clinical judgment, and experience and expertise should easily circumvent the alarming medicalization at all costs of behavior (which does not actually seem to be the case, hence the aforementioned epidemic). However, in situations of a more public nature, commonly magnified and dramatized by the media, psychiatric illness leaves the clinic and enters the courtroom and the news, and becomes a matter of curiosity, often morbid, and of public debate. As an example of this, the authors present the case of serial killer Jeffrey Dahmer and of the development of a myth regarding his unproven diagnosis of AS, a form of autism (M. T. Palermo, Palermo, & Federico, 2003). The relevance of this case is in relation to a number of facts. First, the diagnosis of AS made on the serial killer in question may have led to an increase in clinical stereotyping of “lone murderers.” Although “lone” and potentially dangerous individuals suffering from AS have been described (M. T. Palermo, 2013), this is hardly the case


Palermo and Bogaerts

3

when it comes to heinous crimes requiring applied executive skills, typically impaired in most individuals with an Autism Spectrum Condition.1 Second, the recent publication of the DSM-5 (APA, 2013) carries a statement that advises caution in forensic use. It underlines the dangers of improper use of the manual by members of the legal profession and the courts. Although a similar disclaimer was present in the previous edition, albeit in a very brief manner and not referring specifically to its use in court (APA, 2000), the current version possibly is in line with fears of a climate of overdiagnosis of psychopathology, seen both in and out of the legal arena. It is further evidence of an often hasty use of descriptive criteria meant for research purposes and for the facilitation of communication between clinicians. Finally, the case in question highlights the dangers of retrospective diagnoses and the inadvertent consequences of a deductive approach to mental life and behavior.

The Case of Jeffrey Dahmer In 1991, Jeffrey Dahmer, a then 31-year-old man, was arrested and incarcerated for the murder and dismemberment, and possible cannibalization, of 17 men. The majority of the homicides took place over the course of a 14-month-period between May 1990 and July 1991, when he was arrested. During that period, he murdered 12 people. Dahmer’s life and macabre deeds have become since then public knowledge and have resulted in a number of informational and popular books, mostly written around the time of his arrest and trial and based on crime scene observations and interviews with family members, and even a movie. Dahmer was assessed by seven expert witnesses following his arrest. Despite the shocking and abominable nature of his crimes, he was considered to be competent to stand trial and eventually was found to be legally sane, that is, cognizant of his actions and legally responsible for each one of the 15 murders with which he was charged. He was diagnosed by most of the experts as suffering from a paraphilia, namely, necrophilia, along with a mixed personality disorder with sadistic, obsessive, fetishistic, and antisocial features (Fulero & Wrightsman, 2008; G. B. Palermo, 2004). Criminologically and legally, he was considered legally sane and formulated as an organized non-social lust murderer. He was sentenced to 15 consecutive life terms in prison. He died at age 34, killed by another inmate, while a prisoner in the Columbia Correctional Institution in Portage, Wisconsin. Dahmer’s developmental history is that of an unhappy, shy, and solitary child. His mother was ill during her pregnancy with him and depressed for most of his childhood. Although his father described him as a normal boy until the age of 12, he was deeply troubled when, at the age of 4, following a double hernia repair, he was convinced that his penis had been cut off. He was a lonely child, often bullied, and he was understandably distressed by his parents’ frequent altercations that, many years later, culminated in a divorce. The family moved several times during his childhood. Although not a serene or productive student, he had friends, played on the school tennis team, though he was not very interested in sports, and was described as a class clown and as a prankster (Purcell in Weatherby, Buller, & McGinnis, 2009). Indeed, he was teased by peers,


4


but it is unclear as to how much of this was actually also part of a common perverse mechanism between bullies and victims. The latter at times enter into a relationship with the victimizer by displays of behavior known to get them further ridiculed. In fact, he was also described as charming (Jentzen et al., 1994). As are many boys who live close to nature, Dahmer enjoyed collecting insects and showed them at school. He also enjoyed dissecting small animals, such as tadpoles, at home and in science class. He also collected and dissected animals he found dead on the road, dogs or foxes, and on at least one occasion, he brought a pig head home from science class and kept the skull. His father recalls that as a toddler, on one occasion, he became “excited” upon hearing the noise of small animal bones rattling in a steel bucket. Early on, Dahmer began to develop an attraction for other boys. In late adolescence, he frequently drank alcohol and used cannabinoids and he grew very overweight. After graduation from high school, he briefly attended college but did not do well academically. In 1980, he joined the U.S. Army, went through basic training, and became a medic. His father described him as “looking like a wonderful physical specimen” following his enlistment and basic training. Throughout his period in the army, while stationed in Germany, his heavy drinking continued. After his discharge from the U.S. Army in 1981, he moved in with his grandmother in West Allis, Wisconsin. While living there, he persisted in his alcohol abuse. Following his arrest in 1991, Dahmer confessed to murdering a total of 17 men, the first one in 1979 and the last in 1999. He skillfully seduced and later drugged most of his victims. Following the murders, he would have anal or oral intercourse with them, photograph them, and then proceed to dismember them, again taking photos of body parts. He dissected and preserved some of his victims’ skulls, which were found at the crime scene.

The Case for AS It has been suggested that Jeffrey Dahmer suffered from AS (e.g., Silva, Ferrari, & Leong, 2002), a childhood onset developmental disorder within the autism spectrum. The eponym Asperger syndrome was removed from the latest fifth edition of the DSM, but in the previous fourth edition, it fell under the rubric of the Pervasive Developmental Disorders and it was considered a form of High Functioning Autism (HFA). Although controversy has long surrounded the mere concept of AS (Frith, 2004; Sharma, Woolfson, & Hunter, 2012), public awareness of the clinical entity developed over the years owing to a sizable number of blogs as well as to the media (Draaisma, 2009). In spite of its clinical nature, common albeit confused knowledge of the illness is linked to ideas of eccentricity, oddity, and a never demonstrated link to criminal behaviors (Ghazziudin, 2013). Suffice it to say that many recent solitary killers have received diagnoses, often purely journalistic, of AS: Anders Breivik, Adam Lanza, James Eagan Holmes, and most recently Elliot Rodgers have all been associated at some point with the eponym. The suggestion was made by several authors that Jeffrey Dahmer may have suffered from AS (Silva et al., 2002). As often happens in the case of claims and rumors



5

(Victor, 1993), however, this has been reiterated but never verified (Haskins & Silva, 2006) and was based on the analysis of his behaviors from a developmental perspective and on published accounts in the media. In their analyses, the authors overlapped syllogistically his childhood and adulthood behaviors alike with the DSM-IV-TR (4th ed., text rev.; APA, 2000) diagnostic criteria for AS. To see the dangers implicit in this approach, it is necessary to delineate briefly the criteria in question. AS was diagnosable following DSM-IV diagnostic criteria in the presence of qualitative impairments in social interaction and restricted, repetitive, and stereotyped patterns of behavior, and in the absence of any language delay or cognitive problems. The social impairment criteria listed difficulties in non-verbal behaviors, such as eye to eye gaze; facial expression; body posture; developmentally appropriate peer relationships; a lack of social and emotional reciprocity; and a lack of seeking to share enjoyment, interests, or achievements. The restricted, repetitive, and stereotyped behavior criteria included an encompassing preoccupation with restricted interests, with an abnormal intensity, along with an inflexible adherence to rituals and routines, motor mannerisms, and a preoccupation with parts of objects. Although all of the above criteria, save for the absence of language and cognitive developmental delay, have been maintained in the current DSM-5 (APA, 2013) chapter on ASDs, AS has been removed as an eponym and as a diagnostic category. This was done for a number of reasons, which are beyond the scope of this writing. On the basis of DSM-IV criteria for AS, a careful analysis was carried out by Silva et al. (2002) following the popularized descriptions of Dahmer’s social skills, of his non-verbal behaviors, and of his alleged restricted interests and repetitive actions. They referenced a memoir by his father (Dahmer, 1994), in which Jeffrey Dahmer is described as having difficulties with “appropriate eye gaze behavior” and having displayed facial expressions that seemed to be devoid of emotional glow” and had “a certain motionless of his mouth” (p. 2). Mr. Dahmer also described his son’s body posture as “rigid and unusual in his straightness” and with an overall “awkwardness reminiscent of a dearth of life force not inconsistent with a zombie like person,” robotic-like, similar to an “unfeeling programmed machine” (Silva et al., 2002). His emotional sense of detachment was fairly evident during his trial according to other sources (Norris, 1992).2 At one point during his childhood, after Dahmer’s father had cleaned out a crawl space under the home, a then 4-year-old Jeffrey would allegedly, “from time to time,” pick up a fistful of bones and let them drop in a steel bucket as he enjoyed the rattle they made. He is said to have, later on, collected the bodies of higher animals. However, Dahmer himself recalled having done this just about four or five times (G. B. Palermo, 2004), hardly what one might describe as collecting. Other reports claim he had indeed a substantial collection of animal remnants, which he had either found or which he killed himself (Nichols, 2006). Dahmer’s father describes himself as yearning for predictability and rigid structure, and as socially fearful and having difficulties with the subtleties of social life. This seems to refer to the concept of the Broader Autism Phenotype (Baron-Cohen & Hammer, 1997; Wheelwright, Auyeung, Allison, & Baron-Cohen, 2010), in which


6


non-autistic relatives of persons with autism may demonstrate milder but qualitatively similar features as those of their affected relative (M. T. Palermo, Pasqualetti, Barbati, Intelligente, & Rossini, 2006). However, besides a high likelihood of recall bias when it comes to his son, it is reasonable to think that because of his own circumstances and his son’s behaviors, and given what he, and the public, knew of the nature and modus operandi of his son, Dahmer’s father may have suffered from a common hindsight bias. This is not uncommon, in fact, even for experts who analyze a behavior a posteriori, let alone for a distraught father subjected to the barrage of media information and to his own inner workings in an attempt to understand what happened. Impressionistic interpretations that are unverifiable are at the basis of profiling and stereotyping. Nonetheless, Dahmer’s father recalls himself as being obsessed with fire and matches during his youth and on one occasion, actually building a hand grenade and wiring a couch with electricity to be able to deliver a shock (Nichols, 2006). On the basis of the above elements and applying DSM-IV diagnostic criteria, the case for Jeffrey Dahmer as suffering from AS was made. Despite his above average to high IQ of 121 (Nichols, 2006), his facial expressions and unusual gaze, his body kinetics, his alleged obsessive and compulsive interest in animal and human body parts, and his lack of a skilled job, along with his inability to develop a long-term relationship, were all thought to be characteristic of AS. His necrophilic behavior was felt to constitute a repetitive and stereotyped pattern of behavior, interest, and activity, as well as evidence of his interest for “parts” as the diagnostic criteria suggest. Furthermore, based on the scientific literature of facial-processing skills in individuals with autism that at the time suggested that when analyzing facial stimuli, some children with ASDs may do so by focusing on single components of the face rather than on the face as a whole, it was suggested that this anomalous visual “parcellation” was at the basis for the dehumanization of human subjects that characterized Dahmer’s crimes. Although the perceptual difference, even in the study cited (Davies, Bishop, Manstead, & Tantam, 1994), is, in fact, not limited to faces or facial expressions, it was oddly considered nonetheless pathoplastic, even if impossible to demonstrate, and a reasonable explanation of the violence towards strangers in which Dahmer engaged. His victims would therefore be seen as parts and not as subjects. Dehumanizing, unfortunately, is a commonly described phenomenon in cases of extreme cruelty (Haslam, 2006) and likely has sociocultural origins rather than neurological ones. It is not hard to see the danger of generalization of such very specific and laboratory-based findings as the ones reported above to Asperger patients as a group and to translate evolving scientific evidence into a basis for such a complex behavior as relating to others in negative or positive ways. (It should be noted that these findings are, as of today, based on mixed evidence.) We do not wish to explore the vast literature of facial processing in AS, but it may be wise to say that readers and students of the field often interchangeably use concepts such as facial processing, emotional processing, and emotional recognition. In fact, however, these concepts are quite different in their social–cognitive ramifications, as well as in their underlying neuroanatomy and neurophysiology. Finally, given the nature of his crimes, it seems only logical that Dahmer would kill strangers, not unlike most serial murderers.



7

Other factors, such as Dahmer’s body kinetics also were felt to be diagnostic or at least highly suggestive of the presence of a developmental disorder. Although there are undoubtedly reported physical fitness problems in persons with AS, if one is to peruse and examine in detail the complexity of basic training in the U.S. Army in the years during which Dahmer was enrolled, it is hard to conceive that such a kinetically abnormal individual would have succeeded in the military (SupaSoldier Chris, 2013). Furthermore, during the initial phases of Dahmer’s trial, in the context of a neurological assessment requested by the court, one of the writers (M.T.P.), then the chief resident in the Department of Neurology of the Medical College of Wisconsin, personally conducted a neurological examination of him, the results of which were normal. At the time of the examination, Dahmer was cooperative and subdued and when asked which arm he preferred to have used for a blood draw for chromosomal analysis, he claimed no preference, but stated to this writer, “I don’t like needles.” Dahmer endorsed items on the Minnesota Multiphasic Personality Inventory (MMPI), which revealed no difficulties in meeting strangers, a natural inclination to initiating and maintaining social conversations, a relative ease in making friends, and a love to go dancing (Nichols, 2006). His MMPI profile, considered valid, demonstrated peak elevations on both the Psychopathic Deviate and Schizophrenia Scales. He was quite skilled at flattery when meeting his victims, with statements such as “Hi, I’m Jeff, I like the way you dance,” or “You’re the nicest guy I’ve met in Milwaukee” (Nichols, 2006), evidence of a substantial social ease and far from the prototypical interpersonal clumsiness characteristic of AS. In addition, he was a competent liar and was able to feign symptoms of insomnia to obtain prescriptions for the anxyolitics that he used to drug his victims. Indeed, shortly prior to his arrest, he had visited the Milwaukee County Psychiatric Crisis Service, possibly to obtain such a prescription, but he left before he could be assessed by one of the psychiatrists on duty (J. Pankiewicz, personal communication, July 29, 1991).

Discussion While attempting to understand and explain even heinous behaviors may lead to an exculpatory attitude towards perpetrators (Miller, Gordon, & Buddie, 1999), the issue of stigma, prejudice, and diagnostic criminal profiling is inherent in the association of complex behaviors with dimensionally defined disorders. For example, among the most heinous behaviors are those of serial killers. However, these killers are frequently charming and seductive, as opposed to having the social clumsiness of the person with an ASD. They are obsessive and meticulous, as anyone who is detail oriented and committed to reaching a goal, even such a deviant one as murder. However, the nature of their behavior and their modus operandi are prone to misunderstanding if one is to try and superimpose in a simplistic way a language-based-diagnostic label on such complex multifactorial behaviors. Dahmer was a serial organized lust murderer (G. B. Palermo, 2004; Purcell & Arrigo, 2006). He was a man hunter (Elbert, Weierstall, & Schauer, 2010). He was target oriented and planned his hunts methodically. The appetitive aggression, which


8


characterized his crimes, associated with the excitement and the subsequent release of endorphins and testosterone, which may have provided him with the sexual potency he lacked (G. B. Palermo, 2004), as in the case of many necrophiliacs (Stein, Schlesinger, & Pinizzotto, 2010), could also, in part, explain the killing spree that antedated his arrest. Dahmer was a lonely, unhappy boy who grew up in an unhappy family with a depressed and emotionally unpredictable mother and a shy father. He was socially avoidant, withdrawn, and as many multiple sexual murderers, schizoid. Although many schizotypal personality disordered adolescents have anamnestic evidence of “autistic features,” the anhedonia and social withdrawal characteristic of a schizoid nature, as seen in Dahmer’s case, are more frequently associated with serial killing and are over-represented in populations of homicidal sex offenders (Bogaerts, Vanheule, & DeClercq, 2005; Hill, Habermann, Berner, & Briken, 2007; Koch, Berner, Hill, & Briken, 2011). Dahmer was never odd, and contrary to the majority of people with AS, he did not long for friendship. In fact, AS individuals are alone as a consequence of their social ineptitude but strongly and at times dysphorically cry out for closeness and belonging. Dahmer’s keeping parts of his victims has been equated with this need for closeness. Growing up with a depressed mother may result in attachment difficulties and later translate into psychopathology (Barker, Copeland, Maughan, Jaffee, & Uher, 2012; Bogaerts, Vanheule, & Desmet, 2006) and social competence dysfunction (Englund, Kuo, Puig, & Collins, 2011). Unpredictable mothering may have lasting effects on developing brain (Baram et al., 2012). Furthermore, maternal depression can affect responsivity to faces and voices, and this from a very early neonatal period (Field, Diego, & Hernandez-Reif, 2009), and this in itself could explain some of the observed phenomenology. In addition, supportive mothering is protective in the social arena (Rubin et al., 2004) and early attachment difficulties may have consequences that are notable even in adolescence (Markiewicz, Doyle, & Brendgen, 2001). Social withdrawal and isolation may further peer problems and result in additional withdrawal (Bowker, Markovic, Cogswell, & Raja, 2012; Bowker & Raja, 2011; Coplan et al., 2013). Likewise, postpartum depression and maternal depression in general have been associated with poor academic performance during childhood and adolescence (Ensminger, Hanson, Riley, & Juon, 2003; Murray et al., 2010), which in itself could at least partially explain Dahmer’s poor performance in school despite his high IQ. Furthermore, peer reputation, which was not the greatest for young Jeffrey, has a marked impact on later academic and occupational attainment particularly in withdrawn and excluded children (Gest, Sesma, Masten, & Tellegen, 2006) and peer victimization, to which he had been subjected (Nichols, 2006), can result in poor grades (Vaillancourt, Brittain, McDougall, & Duku, 2013). In other words, there are more common reasons than an ASD to justify poor scholastic achievement in the presence of a normal to high IQ. In addition, in light of his own personal life circumstances, the possibility that Dahmer was chronically dysthymic is another plausible reason for several of the noted behaviors, such as the drinking, the occasional clowning around, the



9

social disaffiliation, and his retreat to solitary activities. This can also be said of many of the observable psychomotor signs of low mood, such as reduced eye contact and a paucity of expressed emotion. It is indeed interesting that the most common co-morbid condition in paraphilic individuals and paraphilic-related disorders is dysthymic disorder (Kafka & Prentky, 1998). Finally, schizoid personality disorder may be easily confused with AS (Fitzgerald & Corvin, 2001). Jeffrey Dahmer was a lonely man, and loneliness has in part been felt to contribute to his life course (Martens & Palermo, 2005). Social skill deficits may compound loneliness, and loneliness itself can result in aggression (Bogaerts et al., 2006; Schinka, van Dulmen, Mata, Bossarte, & Swahn, 2013). The origin of this may have stemmed from his difficult family environment and likely from the frequent bullying to which he was subjected (Segrin, Nevarez, Arroyo, & Harwood, 2012). Envious of other boys as an adolescent, he had fantasies of killing them (G. B. Palermo, 2004). Over the years, he may have transformed his early aggressive fantasies into his macabre killings (Smith, Fischer, & Watson, 2009). Furthermore, his own issues with body and body parts may have had a very early origin following his hospitalization at the tender age of 4, for which it is quite possible he had not been properly prepared. Fear of being mutilated in hospitalized children is not rare (Petrillo, 1972). It is possible that common childhood phobias and fears (Muris, Merckelbach, Mayer, & Prins, 2000), coupled with his imagination and his own idea of having lost his penis, given the anatomical proximity to the area of his hernia repairs, may have acted as a powerful force in shaping his future relationship with male anatomy. The case of Jeffrey Dahmer is a sad example of the consequences of the improper use of a nosographic category system and of a common tendency to “make a diagnosis fit,” unfortunately a worrisome trend in modern psychiatry. Clearly, the DSM-IV-TR (APA, 2000) diagnostic criteria, in light of the apparent relative ease in their crosssectional application, may have in part contributed to the conundrum. When Wing (1981) reviewed the work of Hans Asperger and paved the way for our current understanding of the condition, she underlined its core features, which were primarily social–cognitive. Later, Gillberg (1991), in confirming the social–cognitive nature of the core symptoms of AS, emphasized that “the all-absorbing narrow interests must be to the exclusion of all other activities” in an affected individual (p.123). In light of his own difficult circumstances and his solitary temperament, it is not surprising that a teased, socially clumsy boy would resort to “things” rather than to people for company. This hardly qualifies as autism. In a further development of much-needed diagnostic instruments for the assessment of AS in adults, Baron-Cohen, Wheelwright, Robinson, and Woodbury-Smith (2005) were even more conservative. In developing the Adult Asperger Assessment (AAA) tool, they underscored that the “parts/systems” component falling under the subheading of repetitive and stereotyped patterns of behaviors, interests, and activities refers to sounds, information, dates, details, numbers, and patterns, not to physical parts or components of an object. Although the AAA appeared long after the attribution of a diagnosis of AS to serial killer Jeffrey Dahmer, the diagnostic criteria of Wing and Gillberg were available many years before his posthumous diagnosis.


10


Although fascination with parts of an object is common in small children in the autism spectrum—wheel spinning for example—it is quite difficult phenomenologically to consider that to be a fascination with the part, but probably more with the act of spinning. And although repetitive behaviors of this type may be seen more commonly in children on the lower end of the autism spectrum (Militerni, Bravaccio, Falco, Fico, & Palermo, 2002), it is very difficult to superimpose the same criteria on sophisticated behaviors such as those involved in collecting, for example, without running the risk of over-diagnosing. Retrospective diagnoses pose one substantial challenge. The impossibility of verification of any hypothesis in light of the absence of the subject on whom one is speculating (Muramoto, 2014). This may be relatively unimportant when attempting to determine whether a prominent historical figure may have suffered from a welldescribed clinical entity, provided ongoing changes in classification systems, such as those for Marfan’s syndrome in the case of Abraham Lincoln or porphyria in King George III (Rushton, 2013), and access to clinical or historical accounts of signs and symptoms is available. In the case of behavioral disorders, however, this becomes quite difficult, if not impossible. Posthumous diagnoses, in fact, become a sort of mereological fallacy (Bennet & Hacker, 2003). Mereology is the system of rules that govern our reasoning about parts and wholes (Harré, 2012). For example, ascribing mental properties and dispositions to brains and their constituents is an example of mereological fallacy. In other words, it is attributing to the parts of something, characteristics which make sense only when they are analyzed as part of a whole. The same, in a way, holds true for contemporary clinical neuroscientific discourse when attempts are made to “blame,” the common term for casual attribution, a complex behavior that developed over the course of a lifetime characterized by a multiplicity of experiences on a given part of the whole of a person, for instance, on a diagnosis. The diagnosis is hence used beyond the linguistic categories used to define observable events (Rosenman & Nasti, 2012) and, in the case of psychiatry, attributed to dysfunctional neural systems. In the specific case of Jeffrey Dahmer, rather than the punishment fitting the crime, it is a case of a diagnosis fitting the crime. The social versus biological dichotomy in the pathogenesis of behavior, and of deviant behavior in particular, is clinically impossible. Obviously, the brain is the “behavior organ,” as the lungs are the “respiratory organ,” but just as air is not of the lungs, behavior is not of the brain. The brain allows us to process information that we receive through experience. And experience has a profound impact even on anatomy. However, we are not our anatomy, as we are not our diagnosis. The concept of association is a risky one as it is easily transformed into causal certainty. And although a medical diagnosis, in the absence of a clear pathogen linked to a symptom, such as a streptococcus pneumoniae recovered from the sputum of a patient with pneumonia, is by definition probabilistic, in law, certainty of an association becomes of extreme importance. Just as smoking is associated with lung cancer but not all smokers develop malignancies, certain individuals with a given psychiatric diagnosis might engage in criminality, one of the many behaviors in humans’ repertoire, but not necessarily in



11

light of their diagnosis. Besides some forms of paraphilia, such as pedophilia, for instance, where criminal diagnosis and criminal behavior coincide, the same is true for the vast majority of psychiatric patients when they are well cared for. Unfortunately, in addition to the growing interest into the neuroscience of evil and its understandable spilling over into forensic psychiatry (Glenn & Raine, 2014), emphasis on dangerousness and criminality in the context of mental disorders is perpetuated by the media (Nesseler, 2011; Stuart, 2006) and AS is no exception (Pourre, Aubert, Andanson, & Raynaud, 2012). Furthermore, psychiatric praxis not uncommonly blends traits with states, resulting in lack of specificity and labeling, both in research and in clinical work. Regardless of the use of diagnostic tools, contemporary scientific literature related to offending behaviors too often uses widely differing conceptual terms, such as deviance, delinquency, crime and violence, to name a few, as if they were synonyms. This further compounds the already existing confusion and stigma surrounding mental illness and dangerousness, also in the field of autism spectrum conditions (M. T. Palermo, 2004). Likewise, the popularization of the DSM has perhaps contributed to a psychiatrization of contemporary society, not unlike what Freudian thought did during an era of dynamic interpretations, which understandably spilled into society at large (Fuller Torrey, 1992). Although diagnostic categories are, by necessity, language based, one must remember the warnings of Chaslin (cited in Berrios, 1996), as early as 1914, that “the inexactitude of the language may cause further inexactitude of our ideas” (p. 109).

Conclusion Although neuroscientific explanations of deviance may indeed prove useful in the laboratory (Markowitsch, 2008), generalization of biological evidence carries the implicit risk of stereotyping and its possible socially relevant consequences (Horstkötter, Berghmans, de Ruiter, Krumeich, & de Wert, 2012). One unforeseen consequence may be the furthering of a situation of dehumanization as well as a deresponsibilization of all agents involved in antisocial behaviors. The paradox is that attempting to classify Jeffrey Dahmer’s monstrous behaviors under a clinical rubric, has, de facto, dehumanized Dahmer himself (Haslam, 2006). Furthermore it has helped perpetuate the myth (or even actually create it as far as the solitary killer is concerned) surrounding the potential for dangerous behaviors in persons with AS. Mechanistically linking his actions with a set of diagnostic criteria transformed him and, of consequence, those suffering from AS into the robotic, unfeeling, and deviant individual whom public opinion has come to fear. This is far from clinical reality and perhaps a dangerous epiphenomenon of a seemingly neoLombrosian contemporary neuroscience of crime. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


12


Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes 1. Despite the nosographic debate based on a number of clinical and biological reasons that led to the removal of Asperger syndrome (AS) from the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), it could be questioned whether patient advocacy groups may have contributed to its removal in light of the ever too frequent casual association between AS and solitary heinous crimes. 2. Not surprisingly, emotional detachment has been described in other cases of trials for heinous crimes, such as that of Adolf Eichman, who reportedly remained calm and collected and never made eye contact with the public for the entirety of his trial (Arendt, 2007). One could easily speak, rather than of the banality of evil, of the impermeability of evil. And while even Adolf Hitler has been associated with AS in yet another retrospective posthumous diagnosis (Fries, 2009), such speculation not only trivializes historical complexity but also perpetuates or creates de novo a modern-day Frankenstein syndrome.

References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. American Psychiatric Association. (2000). Diagnostic and statistical manual (4th ed., text rev.). Washington, DC: Author. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing. Arendt, H. (2007). La banalitá del male [The banality of evil]. Milan, Italy: Universale Economica Feltrinelli. Baram, T. Z., Davis, E. P., Obenaus, A., Sandman, C. A., Small, S. L., Solodkin, A., & Stern, H. (2012). Fragmentation and unpredictability of early-life experience in mental disorders. The American Journal of Psychiatry, 169, 907-915. Barker, E. D., Copeland, W., Maughan, B., Jaffee, S. R., & Uher, R. (2012). Relative impact of maternal depression and associated risk factors on offspring psychopathology. The British Journal of Psychiatry, 200, 124-129. Baron-Cohen, S., & Hammer, J. (1997). Parents of children with Asperger syndrome: What is the cognitive phenotype? Journal of Cognitive Neuroscience, 9, 548-554. Baron-Cohen, S., Wheelwright, S., Robinson, J., & Woodbury-Smith, M. (2005). The Adult Asperger Assessment (AAA): A diagnostic method. Journal of Autism and Developmental Disorders, 35, 807-819. Bennet, M. R., & Hacker, P. M. S. (2003). Philosophical foundations of neuroscience, Part 1-3. Oxford, UK: Blackwell. Berrios, G. E. (1996). The history of mental symptoms. Cambridge, UK: Cambridge University Press. Bogaerts, S., Vanheule, S., & DeClercq, F. (2005). Recalled parental bonding, adult attachment style, and personality disorders in child molesters: A comparative study. The Journal of Forensic Psychiatry & Psychology, 16, 445-458. Bogaerts, S., Vanheule, S., & Desmet, M. (2006). Feelings of subjective emotional loneliness: An attachment exploration. Social Behavior and Personality, 34, 797-812.



13

Bolton, D. (2013). Overdiagnosis problems in the DSM-IV and the new DSM-5: Can they be resolved by the distress-impairment criterion? Canadian Journal of Psychiatry, 58, 612-617. Bowker, J. C., Markovic, A., Cogswell, A., & Raja, R. (2012). Moderating effects of aggression on the associations between social withdrawal subtypes and peer difficulties during early adolescence. Journal of Youth and Adolescence, 41, 995-1007. Bowker, J. C., & Raja, R. (2011). Social withdrawal subtypes during early adolescence in India. Journal of Abnormal Child Psychology, 39, 201-212. Coplan, R. J., Rose-Krasnor, L., Weeks, M., Kingsbury, A., Kingsbury, M., & Bullock, A. (2013). Alone is a crowd: Social motivations, social withdrawal, and socioemotional functioning in later childhood. Developmental Psychology, 49, 861-875. Dahmer, L. (1994). A father’s story. New York, NY: William Morrow. Davies, S., Bishop, D., Manstead, A. S., & Tantam, D. (1994). Face perception in children with autism and Asperger’s syndrome. Journal of Child Psychology and Psychiatry, 35, 1033-1057. Draaisma, D. (2009). Stereotypes of autism. Philosophical Transactions of the Royal Society of London, Series B: Biological Sciences, 364, 1475-1480. Elbert, T., Weierstall, R., & Schauer, M. (2010). Fascination violence: On mind and brain of man hunters. European Archives of Psychiatry & Clinical Neuroscience, 260(Suppl. 2), S100-S105. Englund, M. M., Kuo, S. I., Puig, J., & Collins, W. A. (2011). Early roots of adult competence: The significance of close relationships from infancy to early adulthood. International Journal of Behavioral Development, 35, 490-496. Ensminger, M. E., Hanson, S. G., Riley, A. W., & Juon, H. S. (2003). Maternal psychological distress: Adult sons’ and daughters’ mental health and educational attainment. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 1108-1115. Field, T., Diego, M., & Hernandez-Reif, M. (2009). Depressed mothers’ infants are less responsive to faces and voices. Infant Behavior and Development, 32, 239-244. Fitzgerald, M., & Corvin, A. (2001). Diagnosis and differential diagnosis of Asperger’s syndrome. Advances in Psychiatric Treatment, 7, 310-318. Frances, A., & Batstra, L. (2013). Why so many epidemics of childhood mental disorder? Journal of Developmental & Behavioral Pediatrics, 34, 291-292. Fries, A. (2009). Hade Adolf Hitler Asperger’s syndrom? [Did Adolf Hitler have Asperger syndrome?]. Lakartidningen, 106, 1201-1204. Frith, U. (2004). Emanuel Miller lecture: Confusions and controversies about Asperger syndrome. Journal of Child Psychology and Psychiatry, 45, 672-686. Fromm, E. (1973). The anatomy of human destructiveness. New York, NY: Holt, Rinehart and Winston. Fulero, S. M., & Wrightsman, L. S. (2008). Forensic psychology (3rd ed.). Belmont, CA: Wadsworth. Fuller Torrey, E. (1992). Freudian fraud: The malignant effect of Freud’s theory on American thought and culture. New York, NY: HarperCollins. Gest, S. D., Sesma, A., Jr., Masten, A. S., & Tellegen, A. (2006). Childhood peer reputation as a predictor of competence and symptoms 10 years later. Journal of Abnormal Child Psychology, 34, 509-526. Ghazziudin, M. (2013). Violent behavior in autism spectrum disorder: Is it a fact or fiction? Current Psychiatry, 12(10), 23-32.


14


Gillberg, C. (1991). Clinical and neurobiological aspects of Asperger’s Syndrome in six families studied. In U. Frith (Ed.), Autism and Asperger’s syndrome (pp. 122-146). Cambridge, UK: Cambridge University Press. Glenn, A. L., & Raine, A. (2014). Neurocriminology: Implications for the punishment, prediction, and prevention of criminal behaviour. Nature Reviews Neuroscience, 15, 54-63. Harré, R. (2012). The brain can be thought of as a tool. Integrative Psychological & Behavioral Science, 46, 387-394. Haskins, B. G., & Silva, J. A. (2006). Asperger’s disorder and criminal behavior: Forensicpsychiatric considerations. Journal of the American Academy of Psychiatry and the Law, 34, 374-384. Haslam, N. (2006). Dehumanization: An integrative review. Personality and Social Psychology Review, 10, 252-264. Hill, A., Habermann, N., Berner, W., & Briken, P. (2007). Psychiatric disorders in single and multiple sexual murderers. Psychopathology, 40, 22-28. Horstkötter, D., Berghmans, R., de Ruiter, C., Krumeich, A., & de Wert, G. (2012). “We are also normal humans, you know?” Views and attitudes of juvenile delinquents on antisocial behavior, neurobiology, and prevention. International Journal of Law and Psychiatry, 35, 289-297. Jentzen, J., Palermo, G., Johnson, L. T., Ho, K. C., Stormo, K. A., & Teggatz, J. (1994). Destructive hostility: The Jeffrey Dahmer case. A psychiatric and forensic study of a serial killer. The American Journal of Forensic Medicine and Pathology, 15, 283-294. Kafka, M. P., & Prentky, R. A. (1998). Attention-deficit/hyperactivity disorder in males with paraphilias and paraphilia-related disorders: A comorbidity study. Journal of Clinical Psychiatry, 59, 388-396. Karenberg, A. (2009). Retrospective diagnosis: Use and abuse in medical historiography. Prague Medical Report, 110(2), 140-145. Koch, J., Berner, W., Hill, A., & Briken, P. (2011). Sociodemographic and diagnostic characteristics of homicidal and nonhomicidal sexual offenders. Journal of Forensic Sciences, 56, 1626-1631. Markiewicz, D., Doyle, A. B., & Brendgen, M. (2001). The quality of adolescents’ friendships: Associations with mothers’ interpersonal relationships, attachments to parents and friends, and prosocial behaviors. Journal of Adolescence, 24, 429-445. Markowitsch, H. J. (2008). Neuroscience and crime. Neurocase, 14, 1-6. Martens, W. H., & Palermo, G. B. (2005). Loneliness and associated violent antisocial behavior: Analysis of the case reports of Jeffrey Dahmer and Dennis Nilsen. International Journal of Offender Therapy and Comparative Criminology, 49, 298-307. McHugh, P. R., & Slavney, P. R. (2012). Mental illness: Comprehensive evaluation or checklist? The New England Journal of Medicine, 366, 1853-1855. Militerni, R., Bravaccio, C., Falco, C., Fico, C., & Palermo, M. T. (2002). Repetitive behaviors in autistic disorder. European Child & Adolescent Psychiatry, 11, 210-218. Miller, A. G., Gordon, A. K., & Buddie, A. M. (1999). Accounting for evil and cruelty: Is to explain to condone? Personality and Social Psychology Review, 3, 254-268. Muramoto, O. (2014). Retrospective diagnosis of a famous historical figure: Ontological, epistemic, and ethical considerations. Philosophy, Ethics and Humanities in Medicine, 28, 910. doi:10.1186/1747-5341-9-10 Muris, P., Merckelbach, H., Mayer, B., & Prins, E. (2000). How serious are common childhood fears? Behavior Research and Therapy, 38, 217-228.



15

Murray, L., Arteche, A., Fearon, P., Halligan, S., Croudace, T., & Cooper, P. (2010). The effects of maternal postnatal depression and child sex on academic performance at age 16 years: A developmental approach. Journal of Child Psychology and Psychiatry, 51, 1150-1159. Nesseler, T. (2011). Narrated truths: The image of psychiatry in the media. European Archives of Psychiatry & Clinical Neuroscience, 261(Suppl. 2), 24-28. Nichols, D. S. (2006). Tell me a story: MMPI responses and personal biography in the case of a serial killer. Journal of Personality Assessment, 86, 242-262. Norris, J. (1992). Jeffrey Dahmer. New York, NY: Windsor Publishing. Palermo, G. B. (2004). The faces of violence (2nd ed.). Springfield, IL: Charles C Thomas. Palermo, M. T. (2004). Pervasive developmental disorders, psychiatric comorbidities, and the law. International Journal of Offender Therapy and Comparative Criminology, 48, 40-48. Palermo, M. T. (2013). Developmental disorders and political extremism: A case study of Asperger’s syndrome and the Neo-Nazi subculture. The Journal of Forensic Psychology Practice, 13, 341-354. Palermo, M. T., Palermo, G. B., & Federico, A. (2003, September 17-20). Psychopathic devious and deviant. When P, D and D are not a developmental disorder. The case of serial killer Jeffrey Dahmer. Presented at the 4th European Conference on Mental Health in Mental Retardation, Rome, Italy. Palermo, M. T., Pasqualetti, P., Barbati, G., Intelligente, F., & Rossini, P. M. (2006). Recognition of schematic facial displays of emotion in parents of children with autism. Autism, 10, 353-364. Petrillo, M. (1972). Preparing children and parents for hospitalization and treatment. Pediatric Annals, 1(3), 24-41. Pourre, F., Aubert, E., Andanson, J., & Raynaud, J. P. (2012). Asperger syndrome in contemporary fictions. Encephale, 38, 460-466. Purcell, C. E., & Arrigo, B. A. (2006). The psychology of lust murder: Paraphilia, sexual killing, and serial homicide. San Diego, CA: Elsevier. Rosenbaum, R. (1999). Explaining Hitler. New York, NY: Harper Perennial. Rosenman, S., & Nasti, J. (2012). Psychiatric diagnoses are not mental processes: Wittgenstein on conceptual confusion. Australian & New Zealand Journal of Psychiatry, 46, 1046-1052. Rubin, K. H., Dwyer, K. M., Kim, A. H., Burgess, K. B., Booth-Laforce, C., & Rose-Krasnor, L. (2004). Attachment, friendship, and psychosocial functioning in early adolescence. The Journal of Early Adolescence, 24, 326-356. Rushton, A. R. (2013). Diagnosing the dead: The retrospective analysis of genetic diseases. The Journal of the Royal College of Physicians of Edinburgh, 43, 1-4. Schinka, K. C., van Dulmen, M. H., Mata, A. D., Bossarte, R., & Swahn, M. (2013). Psychosocial predictors and outcomes of loneliness trajectories from childhood to early adolescence. Journal of Adolescence, 36, 1251-1260. Segrin, C., Nevarez, N., Arroyo, A., & Harwood, J. (2012). Family of origin environment and adolescent bullying predict young adult loneliness. The Journal of Psychology, 146, 119-134. Sharma, S., Woolfson, L. M., & Hunter, S. C. (2012). Confusion and inconsistency in diagnosis of Asperger syndrome: A review of studies from 1981 to 2010. Autism, 16, 465-486. Silva, J. A., Ferrari, M. M., & Leong, G. B. (2002). The case of Jeffrey Dahmer: Sexual serial homicide from a neuropsychiatric developmental perspective. Journal of Forensic Sciences, 47, 1347-1359. Smith, C. E., Fischer, K. W., & Watson, M. W. (2009). Toward a refined view of aggressive fantasy as a risk factor for aggression: Interaction effects involving cognitive and situational variables. Aggressive Behavior, 35, 313-323.


16


Stein, M. L., Schlesinger, L. B., & Pinizzotto, A. J. (2010). Necrophilia and sexual homicide. Journal of Forensic Sciences, 55, 443-446. Stuart, H. (2006). Media portrayal of mental illness and its treatments: What effect does it have on people with mental illness? CNS Drugs, 20, 99-106. SupaSoldier Chris. (2013). US basic training in the 80s. Retrieved from www.youtube.com/ watch?v=1Z2ph7LrB64 Vaillancourt, T., Brittain, H. L., McDougall, P., & Duku, E. (2013). Longitudinal links between childhood peer victimization, internalizing and externalizing problems, and academic functioning: Developmental cascades. Journal of Abnormal Child Psychology, 41, 1203-1215. Victor, J. S. (1993). What is a rumor. In J. S. Victor (Ed.) Satanic panic: The creation of a contemporary legend (pp. 57-59). Chicago, IL: Open Court. Weatherby, G. A., Buller, D. M., & McGinnis, K. (2009). The Buller–McGinnis Model of serial homicidal behavior: An integrated approach. Journal of Criminology & Criminal Justice Research Education, 3(1). Retrieved from http://www.scientificjournals.org/journals2009/ articles/1441.pdf Wheelwright, S., Auyeung, B., Allison, C., & Baron-Cohen, S. (2010). Defining the broader, medium, and narrow autism phenotype among parents using the autism spectrum quotient (AQ). Molecular Autism, 1, 1-9. Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological Medicine, 11, 115-129.
