Books and Media where input from forensic mental health clinicians pillar his relationship with Sadoff. “I believe that [Dr. have informed her day-to-day interactions with cli- Sadoff’s] career is a template for forensic psychiatrists ents and helped serve justice in a compassionate in each of these areas of social policy. His work con- manner. Collaboration among psychiatry and tinues to be an inspiration for all of us” (p 258). So, other fields is a predominant theme throughout too, is this book. the text, and particularly in the section on “Foren- sic Psychiatry and Other Professions.” In this Reference manner, it appeals to a wide audience of mental 1. Levin A: Founder of modern forensic psychiatry honored with health clinicians, forensic practitioners, lawyers, Guttmacher Award. Psychiatric News 52:13(14), 2017 and educators, among others. Jennifer L. Piel, MD, JD The section on “Future Directions” will appeal to Seattle, WA readers interested in neurolaw and the developing role for neuroscience in court cases. Consistent with Disclosures of financial or other potential conflicts of interest: None. other book sections, the section begins with a brief historical summary of the use of neuroscience-based expertise in medicolegal contexts. Reviewed are re- cent developments in neuroscience research and how Mindhunter research may be used in criminal and civil cases. The Screenplay by Joe Penhall, Jennifer Haley, Erin Levy, last chapter in the section clearly discusses the current and Carly Wray. Produced by David Fincher, Charlize limitations on the use of neuroscience research in Theron, Joe Penhall, et al. A web television series on individual cases. Netflix. The first of 10 episodes in Season One aired Despite spanning such breadth of forensic psychi- on October 13, 2017. atry, from the early beginnings as a specialty to the To understand the “artist,” you must study his “art”...andif future of neuroscience research, the book is cohesive you want to understand the criminal mind, you must go in that it allows the reader to follow the field through directly to the source and learn to decipher what he tells its development. If there is a criticism, it is that the you. John E. Douglas1 authors, collectively, may be too positive about the evolution and trajectory of forensic psychiatry and Mindhunter is based on the book Mindhunter: Inside partnerships across medical and legal disciplines. Al- the FBI’s Elite Serial Crime Unit, written by John E. though there is good reason to be proud of the field, Douglas and Mark Olshaker. The series has been some chapters may impress upon readers that there renewed for a second season. The story is set in 1977 are few challenges left to overcome. However, with and chronicles two Federal Bureau of Investigation an increasing population of justice-involved patients (FBI) agents’ odyssey into the nascent field of crim- and increased referrals for medicolegal assessments, it inal psychology and profiling at a time when the term is important to recognize that there is more work to “serial killer” was not yet in widespread use. The two be done. agents, Holden Ford (Jonathan Groff) and Bill Sadoff begins the book with a dedication to his Tench (Holt McCallany), are based on FBI agents mentors, teachers, colleagues, students and those John E. Douglas and Robert K. Ressler, respectively. served by forensic psychiatry. With his passing in Both are now real-life profiling legends who, along April 2017, it cannot go unrecognized that the chap- with other greats, such as Roy Hazelwood, are cred- ter authors, through their strong contributions to the ited with pioneering the field of psychological profil- text as well as some personal acknowledgments in ing and its current evolution: behavioral analysis. the book, honor Sadoff and his contributions to the Though ostensibly a crime thriller, the series’ maca- field of forensic psychiatry. In concluding the chap- bre subject matter causes many to find that it strays ter on “Forensic Psychiatry and the Law: Litigation, into the horror genre. Despite the gruesome subject Advocacy, Scholarship and Teaching,” Michael L. matter, on-screen violence and gore are minimal, Perlin, JD, shares his view on the relationship be- save for the split-second flashes of bloodied corpses in tween psychiatry and the law. He identifies four core the opening sequence. Much of the dialogue between pillars to this relationship: litigation, teaching, schol- the FBI agents and serial killers is taken directly from arship, and advocacy. He adds as a fifth personal real transcripts.

Volume 46, Number 1, 2018 133 Book and Media

The first episode cold opens with a standoff, where his sidearm, and absolve the correctional facility of Agent Ford is negotiating with the armed hostage liability should Kemper harm him. As the corrections taker, who is revealed to be a psychotic man, non- officer spells out the various ways that harm could compliant with medication, who has developed a de- manifest (“murder, assault, general abuse, or being lusion that he is becoming invisible. Despite his de- dragged into a hostage situation”) Agent Ford’s facial lusion, the man’s impetus for taking five people expression reveals that he may not have fully appre- hostage is revealed to be a fight with his wife. Despite ciated the situation in which he currently finds him- Agent Ford’s best efforts, not everyone survives the self. Ford is then led deeper into the belly of the standoff. Although the FBI declares the outcome a correctional facility to conduct the interview in a success, Ford is visibly unsatisfied, as he is acutely sequence that should appear relatively familiar to fo- aware of his lack of insight into the mind of the rensic psychiatrists who have evaluated criminal de- hostage taker. Desperate for answers and surrounded fendants and prisoners in correctional facilities. by colleagues lacking in curiosity, Ford starts to audit Eventually, Kemper is led into the room by correc- classes at the University of Virginia (UVA) on crim- tional officers, with the ominous thuds of his foot- inal psychology and is immediately hooked. He be- steps and clanking of his shackles preceding his ap- comes obsessed with understanding this new breed of pearance. Standing at 6 feet 9 inches and weighing murderer: one who does not kill for the advancement 300 pounds, the bespectacled Kemper has an over- of traditional criminal interests, such as murderers whelming presence and dwarfs everyone in the room. connected with organized crime. When he informs Britton’s Kemper is arguably the star of the show. his superior of his new interest, he is chastised and He flawlessly demonstrates the traits and demeanor told that the study of psychology is frowned upon. one would expect of a psychopathic necrophile2 who Ford tries discussing his new-found interest with the has murdered 10 people. Using his powers of cha- professors at the UVA and finds that they are not risma and manipulation, Kemper’s agenda is to make fond of speaking to agents of law enforcement. This sure Ford realizes he is not only physically, but also dynamic appears representative of the long-standing, intellectually, inferior, “You can spell oeuvre, can’t progress-hampering lack of collaboration between you?” Kemper’s chef d’oeuvre, however, is not a paint- law enforcement and mental health. ing or a sculpture, but rather the series of eight grisly Isolated, yet driven, Ford bumps into fellow Agent necrophilia-driven murders he committed before Bill Tench in the cafeteria. Tench is employed in the turning himself in to the police out of boredom. One Behavioral Science Unit (BSU) of the FBI (which in of Mindhunter’s most stomach-churning moments is real life evolved into what is now called the Behav- arguably when Kemper matter of factly explains the ioral Analysis Unit), and travels the country speaking difference in the mechanics of sodomizing a corpse to local law enforcement regarding criminal behavior versus tracheoesophageal sex with a severed head. and motives. Ford is nonetheless frustrated by his Despite the brutality of his crimes, Kemper appears new “road school” gig. He does not believe that the to have a surprising capacity for introspection. He duo has an adequate understanding of deviant psy- partially attributes his intact insight to his six-year chology to truly assist the law enforcement officers commitment at the Atascadero State Hospital at age whom they encounter in the classes in solving the lust 15, after he was adjudicated not guilty by reason of murders on which they are consulted. During one insanity (NGRI) for his grandparents’ murders. Agent such outing, Ford stumbles upon an opportunity to Ford meets with Kemper several times throughout the speak with a particularly gregarious prison inmate, course of the series. Over time, Kemper’s charm and convicted of numerous lust murders. manipulative abilities weaken Agent Ford’s boundaries. Edmund Kemper III (played by Cameron Britton, Ford begins to relate to Kemper as less of a subject and who bears a striking resemblance to the real-life more of a friend. Kemper) is the first subject that Agent Ford inter- After his encounter with Kemper, Ford and Tench views alone, because Agent Tench finds the idea of are called into their supervisor, Agent Shepard’s speaking with “The Coed Killer” Kemper far less (Cotter Smith), office. Shepard is furious to learn appealing than golfing. There is a darkly humorous that an FBI agent was secretly meeting with a “se- scene preceding the interview, in which a corrections quence killer” such as Kemper. Tench, who has more officer informs Agent Ford that he must surrender experience and political tact than Ford (Ford is actu-

134 The Journal of the American Academy of Psychiatry and the Law Books and Media ally comically inept at navigating bureaucratic poli- contempt, Ford continues to be captivated by them. tics), is able to temper the angry Shepard, and lays Ford begins receiving “fan mail” from Kemper and out the potential gains for law enforcement in study- proudly displays the letters in his office. He starts to ing killers such as Kemper. Tench points to a recent integrate some of the more abhorrent and misogynis- unsolved murder that has a local law-enforcement tic phrases uttered by some of his subjects into his agency completely stumped as an example of the po- interviews in an effort to build rapport with suspects tential benefits better insight into the minds of men and interviewees, which Tench views as distasteful such as Kemper may afford the FBI. Shepard ac- and somewhat disturbing. In a particularly poignant knowledges the merit in this idea, but finds the sub- scene, Ford strategically places items and clothing ject so sordid that the work would need to be hidden. that belong to the victim (and others that he had He then informs Ford and Tench that they are to purchased to appear to have belonged to the victim) relocate their offices to the building’s basement to in an interrogation room for the purpose of sexually continue their research into criminal psychology. exciting and intimidating the suspect. In addition, Tench and Ford later meet with Dr. Wendy Carr Ford makes several explicit statements to the suspect (Anna Torv), whom Tench has known for years. about how good it must have felt to have violated the Carr is a psychology professor working toward tenure young woman. At one point, he ends up quoting at a university in Boston, Massachusetts. Her char- Kemper verbatim. Though Ford begins to see him- acter is based on Dr. Ann Wolbert Burgess, a psy- self as possessing a unique gift for understanding the chology professor at Boston College who worked minds of lust murderers, others begin to notice with Agents Douglas and Ressler, and helped to se- changes in his personality. His girlfriend begins to see cure grant-funding for their work. At the time the him as distant and more aggressive. He begins to run two agents meet with Dr. Carr, she explains that she afoul of bureaucratic policy and responds with angry is working on a book detailing the prevalence of psy- defiance, rather than his usual aloofness, and begins chopathy in prominent, white-collar professions, boasting about his exploits to those willing to listen. such as law, medicine, and business. She postulates The impact that his work has upon his character that the murderers whom Ford and Tench are at- development is one of several themes of the series tempting to study are not psychologically distinct from the white-collar criminals and exploiters she is that forensic psychiatrists will find interesting. studying. She suggests that the difference lies in their Forensic psychiatrists may be interested in how “different leanings”: sexual sadism for the agents’ the series stresses recording interviews. Recording the group and financial conquest for hers. Carr excitedly agents’ interviews of the killers is a central plot point; discusses how important this research is, not just to Mindhunter’s opening sequence features a tape re- law enforcement, but to several different fields in- corder being prepared, and there is a significant sub- cluding general psychology. She endeavors to secure plot involving a recording of one of the agents’ inter- grant funding for their work, and implores the agents views. Proponents of recording forensic evaluations to take a structured, consistent approach to their in- point to the fact that recording an evaluation pre- terviews to obtain scientifically sound data. The BSU serves the integrity of the interview and protects the division’s psychological profiling project begins to forensic psychiatrist against accusations of miscon- 3 grow in both scope and legitimacy after Carr’s duct. The series dramatically features the converse involvement. situation, where impropriety preserved on a record- The series then follows Ford and Tench as they ing presents a serious problem. Many scenes feature interview several other “sequence killers,” including members of the BSU listening to recordings of inter- serial killer Monte Rissell (Sam Strike), necrophile views in their basement office. These scenes some- and women’s shoe fetishist Jerry Brudos (Happy An- times appear to be reminiscent of peer review. Dr. derson), and Chicago nursing-student mass mur- Carr lends expertise by commenting on the agents’ derer Richard Speck (Jack Erdie). They begin to use choice of language, style of questioning, and overall what they have learned from interviewing these con- interview content. These scenes raise an interesting victed murderers to assist local law enforcement in point: recording one’s evaluations may give forensic solving sexually motivated homicides. Whereas psychiatrists a powerful tool to review the quality of Tench views his interview subjects with an air of their evaluations and the option to seek peer review

Volume 46, Number 1, 2018 135 Book and Media for the process of their work, rather than the final Bradford candidly discussed how he developed post- product, reports and testimony. traumatic stress disorder (PTSD) from what he had One of the series’ central themes involves sexuality been exposed to over the course of his career. He and sexual deviancy. Agent Tench is portrayed as a stated that the PTSD was acutely precipitated by conservative, masculine figure, and is contrasted reviewing material related to a case involving a serial against Agent Ford’s more boyish and latitudinarian sexual homicide, and he had to turn down a high- proclivities. All the crimes that the duo investigates profile case because of the toll it took.7 throughout the series are motivated by the killers’ Agent Tench, despite his gruff and macho out- desire for sexual gratification. Numerous paraphilias ward persona, recognizes the toll the work is taking, are featured throughout the course of the series. and remarks that the duo’s interview with Brudos Tench views the paraphilias with open disgust, was, “like standing next to a black hole.” While he is whereas Ford begins to see them as curious oddities able to turn to his wife for support (she realizes the to be explored, understood, and catalogued. Dr. Carr horrors of what he is dealing with at work), Agent is revealed to be lesbian, and the series is set a mere Ford lacks such introspection, and begins to psycho- four years after homosexuality had been removed logically unravel. He becomes less able to maintain from the Diagnostic and Statistical Manual of Men- appropriate boundaries with interviewees and finds tal Disorders, Second Edition, as a mental illness.4 himself disclosing intimate details of his life to them. Although hopeful for a societal change of attitude, The series ends with Ford’s experiencing a panic at- she is cognizant that her own sexuality may still be tack inside a prison and reeling from a life-threaten- viewed by many as deviant. This dynamic culminates ing miscalculation because of his erosion of profes- in a tense moment between Tench and Carr which sional boundaries. seems to represent Carr’s worry about whether the Finally, the concept of professional boundaries, FBI will accept her lesbianism. and their paramount importance to the practice of The series’ episodes typically begin with a cold psychiatry will be familiar to the forensic psychiatrist. open of a mustachioed Kansas-area man (played by The protagonists in Mindhunter are frequently alone Sonny Valicenti and credited simply as “ADT Ser- and interacting with exceptionally malignant psy- viceman,” but clearly meant to be Dennis Raider, chopaths as they try to learn how to think like the better known to the public and law enforcement as subjects of their study. As a result, they are bom- the bind-torture-kill (BTK) killer), initially carrying barded by the killers’ noxious psychological defense out seemingly innocent errands, albeit with an iso- mechanisms, deviant fantasies, and manipulations. lated affect and a rigid need for rules and order that They become the receptacles for the killers’ projec- make his actions appear menacing. As the series pro- tions, projective identification, and malignant pseu- gresses, these errands start to become more sinister. doidentification. By trying to think like the killers, Eventually, it becomes clear that his previous duties the protagonists’ work brings them frighteningly were actually meticulous preparation and planning close to their own unconscious and unacceptable im- for hunting victims. These scenes serve as a stark pulses. The toll that this kind of work takes is com- reminder that, while Agents Holden and Ford are pounded even further by the work–life imbalance studying captured serial killers, others are active and that develops for Agent Ford; in the series, he is on the prowl, proving the veracity of Kemper’s shown working 10- to 12-hour days on “road school” words: “You know, there’s a lot more like me.” This and spending his weekends interviewing serial killers. underscores the importance of the work the BSU is This leaves very little time for Agent Ford to pursue a doing, despite the toll it is taking on its agents. life outside of work. Here again, art parallels life, as The changes that Agent Ford’s character starts to John Douglas has detailed how grueling work hours undergo as the show progresses are likely to resonate and exposure to appalling cases eventually caused se- with the forensic psychiatrist. Several studies have rious health problems.1,8 demonstrated the impact of vicarious trauma on legal In sum, we believe forensic psychiatrists would professionals, such as judges,5 and even forensic psy- enjoy viewing the Netflix series Mindhunter.Itis chiatrists themselves.6 The most compelling recent likely to captivate anyone with an interest in the his- example of this is former American Academy of Psy- tory of behavioral analysis and serial homicide. Sev- chiatry and the Law president John Bradford. Dr. eral key themes will resonate strongly with forensic

136 The Journal of the American Academy of Psychiatry and the Law Books and Media psychiatrists; most notably the impact of vicarious judges in a single jurisdiction. J Am Acad Psychiatry Law 37:214– 24, 2009 trauma and the struggle to maintain a reasonable 6. Woods AG: When the psychiatrist has PTSD. Psychiatric Times, work-life balance. The series’ depiction of the impor- November 24, 2015. Available at: http://www.psychiatrictimes. tance of recording evaluations will be of interest. Fi- com/ptsd/when-psychiatrist-has-ptsd. Accessed November 14, nally, most should appreciate the message of the vital 2017 7. Colley SB: Evil seeps in: forensic psychiatrist suffers PTSD after necessity of collaboration between law enforcement murder cases. The Chronicle Herald. Halifax, Nova Scotia, May and mental health professionals. 15, 2015. Available at: http://thechronicleherald.ca/metro/ 1286887-evil-seeps-in-forensic-psychiatrist-suffers-ptsd-after- References murder-cases. Accessed November 14, 2017 1. Douglas JE, Mark O: Mindhunter: Inside the FBI’s Elite Serial 8. Douglas JE, Mark O: The Anatomy of Motive: The FBI’s Legend- Crime Unit. New York: Scribner, 1995 ary Mindhunter Explores the Key to Understanding and Catching 2. Rosman JP, Resnick PJ: Sexual attraction to corpses: a psychiatric Violent Criminals. New York: Scribner, 1999 review of necrophilia. J Am Acad Psychiatry Law 17:153–63, 1989 3. Pitt SE, Spiers EM, Dietz PE, et al: Preserving the integrity of the Ian C. Lamoureux, MD interview: the value of video tape. J Forensic Sci 44:1287–91, 1999 Cleveland, OH 4. American Psychiatric Association: Diagnostic and Statistical Man- ual of Mental Disorders, Second Edition. Washington, DC: Amer- James L. Knoll, IV, MD ican Psychiatric Association, 1973 Syracuse, NY 5. Miller MK, Chamberlain J: Evidence of secondary traumatic stress, safety concerns, and burnout among a homogeneous group of Disclosures of financial or other potential conflicts of interest: None.

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