How Forensic Psychiatry Informs Trials

Guests

Dr. Ronald Schouten, associate professor, Harvard, and co-author, Almost A Psychopath
Jim Silver, criminal defense attorney and co-author, Almost A Psychopath

James Holmes, the former neuroscience student accused of killing 12 people and injuring 58 others in the Colorado movie theater massacre, has been formally charged with 24 counts of murder. The case will likely involve questions about Holmes' psychiatric condition and competency to stand trial.

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NEAL CONAN, HOST:

This is TALK OF THE NATION. I'm Neal Conan in Washington. Ten days ago now, a gunmen left 12 dead and 58 injured in Aurora, Colorado. The man accused, James Holmes, faces 142 criminal charges after a court appearance this morning, including 12 counts of murder with extreme indifference to the value of human life. Court documents last week revealed that Holmes had seen a psychiatrist at the University of Colorado and the case may include analysis of Holmes' mental health and whether he's competent to stand trial.

So how does a court determine a defendant's mental state at the time of the crime and at a trial? Today, forensic psychiatry in the justice system. We want to hear from forensic psychiatrists and from those who work with them - lawyers, judges, medical professionals. Call and tell us what we don't know. Our phone number: 800-989-8255. Email us: talk @npr.org. And you can also join the conversation on our website. Go to npr.org. Click on TALK OF THE NATION.

Later in the program, Bill Keller on the opinion page this week, yes, the real Bill Keller about today's actual column on baby boomers and entitlements. WikiLeaks published a fake Bill Keller column over the weekend. But first, forensic psychiatry. We're joined by Dr. Ronald Schouten, associate professor of psychiatry at the Harvard Medical School, and Jim Silver, a former federal prosecutor, now a criminal defense attorney.

They're the co-authors of a book, "Almost a Psychopath." And they both join us from a studio on the Harvard campus. Thanks very much for coming in.

DR. RONALD SCHOUTEN: Thanks for having us.

JIM SILVER: Thank you. We appreciate it.

CONAN: And let's start with the defense attorney, Jim Silver. You get a high profile murder defendant. Under what circumstances do you call in a forensic psychiatrist?

SILVER: Well, in a case like this, I think you have to be thinking about a mental health defense right away, and I think the defense attorneys will call in a forensic psychiatrist and do some evaluations almost immediately. Whether they ever use that to challenge competency or to later present an insanity defense is open to developments in the case investigation. But I think they would be remiss in not doing that right away.

CONAN: And when you talk about evaluations - interviews, essentially, with the defendant.

SILVER: Yes. Absolutely. They'll be interviews with the defendant. The defense team will also be spending an awful lot of time gathering information. They're going to want all his medical records, if there's any psychiatric records. Anything that would be relevant to that investigation, they're going to want to have that available to whichever psychiatrist or psychologist they bring in for an evaluation. And they may bring in a couple.

CONAN: All right. And Dr. Schouten, I say that to you. Where do you begin?

SCHOUTEN: Well, we begin first of all with a review of all of the available records and certainly starting with the police reports and the charges that have been filed against the individual. The roles for the psychiatrist or psychologist brought in may vary in some cases such as, you know, in a complicated case like this a mental health professional, forensic mental health professional, may be brought in primarily as a consultant to the defense team without really anticipating that that person will testify at trial. So they become very much a part of the defense team and their comments, their reports, are kept confidential.

But assuming there's someone who's retained on the competency to stand trial issue or criminal responsibility, that person would again review all the available records, spend time with the person, spend time observing them, interacting with them, and assessing them around the fundamental issues that we look at in competency.

CONAN: And would there be tests in addition to interviews?

SCHOUTEN: You know, there have been a number of efforts to develop specific structured instruments that look at competency to stand trial. They all have a few problems with them, so really it goes back to extended observation and extended interviews that focus on the defendant's ability to consult with his attorney to a reasonable degree and also their rational and factual understanding of the charges against them.

CONAN: But might you order something like an MRI to see if there's a tumor pressing on part of the brain or something like that?

SCHOUTEN: Well, certainly part of it is a thorough psychiatric evaluation and that includes looking at medications the person is taking, underlying medical conditions, underlying neurological conditions, which as you point out, Neal, could include an MRI to look at any brain abnormalities, and then a thorough clinical psychiatric interview occasionally with psychological testing.

CONAN: Jim Silver, now put on your former hat, that of a federal prosecutor, and let's go through this again. When would you start calling in a forensic psychiatrist?

SILVER: Well, technically the way it works in most states and in the federal system is the defendant has to formally tell the court and the prosecution that he or she is going to present an insanity defense. So technically - and that could be months into the case - so technically a prosecutor could wait until they get that formal notification. Lots of times, though, it becomes pretty obvious that a mental health defense is going to be part of the trial.

So pretty much right away the prosecutor will start figuring out does he want to or she want to ask for an evaluation. The prosecutor could bring up an issue of competency if he or she sees that, but probably will begin preparing for an insanity defense right away by consulting their own experts. And as Dr. Schouten said, they may have their own sort of consultant just working with them and trying to help them anticipate issues that may arise should the insanity defense be raised.

CONAN: So they'll have somebody on retainer, say, from one of the local institutions?

SILVER: Sure. They'll bring in a doctor and start consulting, maybe right away, especially in a case like the Aurora shooting or many other cases where it's apparent that a mental health defense is going to be part of the case. So, you know, almost right away they'll be thinking about it too. I mean, in some cases it's obvious where it's probably going to go and they'll start preparing right away.

CONAN: Mm-hmm. And what kinds of questions would the forensic psychiatrist, Dr. Schouten, what kind of questions would you be answering for the defense and what kind of questions for the prosecution?

SCHOUTEN: They're all the same questions. So in addition to getting a thorough psychiatric history, it's what we call a mental status examination, looking at the content and the form of the person's thought, whether they're affected by any sort of mood or anxiety disorder, whether they have a psychotic disorder.

So those general clinical questions, whether there's impairment of their thinking, sort of cognitive impairment of any sort. But then a very focused examination on their knowledge of the charges, their relationship with their attorney, whether they think the attorney is on their side or against them, what's the role of the judge, what's the role of the prosecutor, what's the role of the defense attorney, what does a jury do. Looking at their understanding, again, whether it's a factual understanding and a rational understanding of the proceedings and what's involved.

CONAN: Because one of the questions you have to answer is: is this person competent to stand trial - in other words, able to assist in his own defense or her own defense.

SCHOUTEN: In part it's able to assist, but the other portion of that is whether they have a rational and a factual understanding of the proceeding. So I've had cases where the person thought that, well, this is really, you know, the case is really about my political beliefs. The case is about the rights of the Catholic people to rise up and form an army and to fight for the pope and therefore - this is the John Salvi case here in Brookline, Massachusetts, a number of years ago.

And whether, you know, the appropriateness of those actions - and really this is a political trial. It has nothing to do with the fact that I murdered two people.

CONAN: Well, if a defendant thinks something like that, they would then - might easily reject the assistance of a forensic psychiatrist.

SILVER: That absolutely happens. This is Jim Silver. That absolutely happens. I had a case where a client was charged with first degree murder. There seemed to be indications, at least to me and the other lawyer, the other defense counsel, that there was a mental health issue but this defendant did not want to raise it. And I think that's a fairly common occurrence. People don't want to be stigmatized. Even if it might be helpful to them, it's sometimes really hard to convince a client to even consider a mental health defense.

SCHOUTEN: And given the success rate, which is very low, for the insanity defense, a person is likely to be convicted and then they head off to prison with sort of their notation and well-known reputation that they have some sort of mental illness and as the saying goes, better to be bad in prison than mad. And people would rather go in as a convicted person rather than someone who narrowly escaped an insanity acquittal.

CONAN: But just to reinforce something Jim Silver just said, these are attempted fairly rarely and succeed even more rarely.

SCHOUTEN: It's true, they're very rarely used. Which is interesting - the public perception is really far out of line with the reality of the insanity defense. There have been studies that have shown that the general public perception is that about 37 percent - so somewhere in the vicinity of 40 percent - of felony cases have some type of mental health defense. That's far from the truth. It's really about 1 percent.

And people also overestimate how often those defenses are successful. They think they're successful upwards of 60 percent of the time. In fact, they're successful less than 25 percent of the time.

CONAN: Let's see if we can get some callers in on the conversations. We wanted to speak today with forensic psychiatrists and those who work with them - the lawyers or the judges. 800-989-8255. Email talk@npr.org. We'll start with Tate, and Tate's on the line with us from Houston.

TATE: Yes, sir. Good afternoon. Thank you for taking my call.

CONAN: Sure.

TATE: One of the things that I've found in my experience and the experience of other attorneys here in Houston dealing with potential insanity cases, beginning with some friends of mine who represented Andrea Yates and then in my own work, is the availability of recordings of sound or video of the defendant during or shortly after the incident causing their arrest, and then the arrest itself.

And it seems like in this case with as many witnesses as there were, the availability of potential security tapes, the police officers getting to the scene and arresting Laughner immediately, that that evidence may be very helpful to the experts, whether they're forensic psychiatrists, forensic psychologists, in seeing what his state of mind was at that time.

CONAN: Laughner, of course Jared Laughner in the Tucson case.

TATE: I mean, not Jared Laughner. Excuse me. The young man in Colorado.

CONAN: Yeah. And why were these recordings so important?

TATE: The recordings - because if you look, for example, you can see the way someone may be presenting themselves - at least in my experience; I haven't seen any of these tapes in the Colorado case - is that say, for example, and these are pretty well publicized, if you look at Andrea Yates who drowned her five children here in Texas some years ago.

CONAN: Mm-hmm.

TATE: If you see the videos that were made by the attorney shortly after her arrest, in jail, you can see a presentation of a mental health episode of some type or another and contrast that with the way that she was several months later after a full treatment regime, being on her medication, etc.

CONAN: Dr. Schouten, would you agree?

SCHOUTEN: Yes. Tate, that's a great point. I had a case here in Massachusetts where a young man killed his mother and we had hours upon hours of digital recordings of him ranting about his paranoid delusions leading up to this event including when he turned finally against his own mother, thinking that she had gone over and joined the conspiracy against him.

And he actually filmed the murder itself. It was quite gruesome. Though you cannot beat the contemporaneous recordings - now, the prosecution may very well come back and say, ah, well, this is all a setup. You know, people were acting crazy for a purpose. But that becomes a question of fact really for the jury to talk about.

CONAN: Ah, interesting. Thanks very much for the call, Tate.

TATE: I have a second question if I can ask.

CONAN: Well, let me put you on hold because we have to take a short break.

TATE: Thank you.

CONAN: All right? I'm going to - I think that - yes, I think that works. I think that works to put somebody on hold.

(LAUGHTER)

CONAN: I'm still getting used to this new equipment. Stay with us. We're talking about forensic psychiatry in the criminal justice system. We want to hear from forensic psychiatrists and those who work with them. Tell us what we don't know. 800-989-8255. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(SOUNDBITE OF MUSIC)

CONAN: This is TALK OF THE NATION. I'm Neal Conan. The suspect in the Colorado theater massacre made his second appearance in court this morning. James Holmes now faces 142 counts related to the mass shooting. He appeared more alert than he was in court last week, though again, he demonstrated little emotion. His hair, still dyed orange but now fading in spots.

When the judge asked if he approved of a delay in his bail hearing until November, Holmes responded with one word: Yeah. A number of victims also showed up for the hearing, including several wearing Batman T-shirts. We don't know yet how Holmes' lawyers plan to defend him or about his mental state either at the time of the shooting or today. There is a good chance, though, mental health may play a role in the case at some point.

And that leads up to our discussion today - forensic psychiatry in the justice system. We want to hear from forensic psychologists and psychiatrists and those who work with them. Lawyers, judges, and medical professionals, tell us what we don't know. 800-989-8255. Email us talk@npr.org. You can also join the conversation at our website. That's at npr.org. Click on TALK OF THE NATION.

Our guests are Dr. Ronald Schouten, associate professor of psychiatry at Harvard Medical School, and Jim Silver, a former federal prosecutor, now a criminal defense attorney in private practice. They're the authors of the book, "Almost a Psychopath: Do I (or Does Someone I Know) Have a Problem with Manipulation and Lack of Empathy?"

And when we went to the break, Tate was on the line with us from Houston. Tate, you're back with us.

TATE: Oh, yes. Thank you. The second question I had was is it's my understanding, and I'm not sure if this is correct, but that Colorado does not have a diminished capacity defense.

CONAN: Jim Silver, can you help us out with that?

SILVER: The specifics of the Colorado laws are not something I'm intimately familiar with because I think - insanity is definitely going to be the defense. I mean, diminished capacity is normally used to say...

TATE: In mitigation.

SILVER: In mitigation, so that the person is not responsible maybe for a first-degree murder because they couldn't form the particular specific intent to kill and so they're going to be guilty of perhaps a second-degree murder. I suppose it's possible it could arise in that case, but I really think it's going to be an insanity defense.

TATE: And that's essentially the state of the law here in Texas and I know that other jurisdictions have been struggling with it. And before I let you go, one of the questions that I will have, leave you with is - something that I've also seen useful and helpful - is that when you have clients like Mr. Holmes who remained in custody pending trial, they oftentimes receive substantial amounts of mental health care in custody.

And we've been able to get those records and the evaluations done and track both the level of treatment and care they're receiving, plus the initial diagnoses and the progress that occurs while they're being medicated and treated in custody and found that to be pretty helpful, both in mitigation and other places.

CONAN: Dr. Schouten?

SCHOUTEN: It's another great point. It emphasizes the importance of having someone get in there early for the defense and evaluate this person, having good documentation, whether it's video or audio recordings, but certainly someone interviewing him. You know, Tate, I'd just add, one of the differences between Texas and Colorado is that in Colorado it is the state's burden. Once the insanity defense is raised, it is the state's burden to prove that the person is legally sane.

TATE: And here we're basically presumed as sane and then we have to prove the insanity defense by a preponderance of the evidence.

SCHOUTEN: Right.

CONAN: Hmm. Interesting.

TATE: And one of the things that happens is there's a statute, though the burdens are not necessarily clearly defined in it, that if there's evidence that someone's intoxicated they lose the benefit of the insanity defense. And that's a challenge. There's a lot of mentally health - mentally ill people self-medicate.

CONAN: Thanks, Tate. Good (unintelligible).

TATE: Thank you.

CONAN: Good points. That was interesting. He was talking about the importance of documentation. There is the material that we're told the defendant sent to the psychiatrist at Colorado State University that didn't get it until after the shootings had occurred. But that's in the hands of the prosecution. The defense wants it, says it's an internal - you know, it's client-patient information and can't be used against him, but presumably they could use it in their defense.

So we'll have to see how that works out. In the meantime, let's to go to Tom and Tom's with us from Madison.

TOM: Yes. Thanks for taking my call. I wanted to talk just briefly about the corollary, the competency issue, although I don't think it's a major issue in this particular case. But you did mention it as one of the topics of today.

CONAN: Mm-hmm.

TOM: And what I've found in my representation of people is that the resistance to finding someone incompetent to stand trial is huge and when referred for treatment, so-called treatment, the actual treatment of it is to try and prove that someone is competent who basically does not have the mental capacity to be competent.

In other words, they'll teach them all about a trial so they can rote repeat what a jury is and what a lawyer is and so forth, but their real ability to help their counsel in a way that would matter in the case is almost nil.

CONAN: So they prep him for the judge's questions as opposed to...

TOM: Yes. And, you know, people with developmental disabilities do not - you know, it's not like you can increase their IQ significantly. And I find that a lot of the people in prisons are people who really did not understand the proceedings that they went through.

CONAN: Jim Silver?

SILVER: Well, that's a great point, Tom, and I think that's true. I think most people who work in criminal law, especially on the criminal defense side, will tell you that it's very, very, very difficult to have a client found incompetent. The system does everything it can to make clients competent. And maybe it is something like Tom suggested, you know, almost teaching them the parts of a trial so they can recite it for the judge.

But certainly the system will spend money on therapy, medications, you know, whatever it takes because - and in fairness, the state and the prosecution deserves a chance to try and prove a person has committed a crime, especially if it's a horrific crime. But the system is definitely geared towards finding people competent.

CONAN: Thanks very much for the call, Tom.

TOM: Thank you.

CONAN: And Dr. Schouten, I wanted to ask - is it in these kind of big profile cases that forensic psychiatry is ordinarily used or are there occasions when TV dramas don't get made out of it?

SCHOUTEN: Oh, we're, forensic psychiatrists and psychologists are involved in cases at every level where there are mental health issues. The vast majority of them, you know, involve disturbing the peace, setting fire in a trash can, robberies, breaking and entering, on up through simple and aggravated assault, bank robbery, and rape and murder.

CONAN: Dr. Ronald Schouten at the Harvard Medical School, and director of law and psychiatry service at Massachusetts General Hospital. Co-author of "Almost of a Psychopath," along with our other guest, Jim Silver, former federal prosecutor, now a criminal defense attorney.

Here is an email question that we have from Don. Please ask your guests to compare and contrast this event and the recent Norway mass murder, vis a vis mental health defense. Suppose the Aurora theater had been a synagogue or a mosque. What I read into that is does bigotry enter into this? Jim Silver?

SILVER: Well, that's a great question and that's exactly the kind of thing people do, is they compare these really horrific newsworthy events. In the other incident we're talking about, the defendant there, Brievik, does not want to present a mental health defense, and he's very clear that he did what he did for a very specific reason.

He's against the Islamic wave that he sees taking over his country, and so he is very clear that he's not a psychopath, he has no mental health issues, and he did what he did for a very rational and specific reason. So, you know, as to the other question, maybe I'll let Dr. Schouten address that, but they're different in that regard. He's clearly not wanting to present a mental health defense.

CONAN: And Dr. Schouten? Bigotry, how does that play into it?

SCHOUTEN: Well, sir, you know, we run into the problem of drawing the distinction between a delusional - delusion, which is a fixed false belief that one holds in spite of evidence to the contrary, and another type of belief, a political belief, an ideological belief. And it is a very vague line and a very tough definition to hammer down.

In the Salvi case, you know, John Salvi had a belief that those of us who evaluated him for the defense thought was a psychotic delusion related to persecution of Catholics in this country and grandiose visions of what they would do to raise an army and have the Pope print money and all these things.

The prosecution argued that this was a - that this was just a rational hate crime and he was of sound mind when he did this and was not eligible for an insanity defense. So very difficult to sort those out. And we can look at the Ted Kaczynski case, many other cases in which mental health issues are raised but, you know, at heart you have to wonder if there was some sort of political motivation.

CONAN: All right. Here's an email. This is from Dee(ph): I appreciate your show and your guests, however, can we spend some time talking real world brass tacks? I spent my legal career defending doctors in med-mal cases and also some cases defending commercial and PI defendants. I have encountered plaintiffs who have psychiatrists, psychologists testify they suffered from myriad illnesses, disorders, that were clearly made-up, e.g., one psychiatrist testified that a woman who was fired from her job for embezzlement and who sued her employer suffered from PTSD. My point: Can some acknowledgement be given to what a racket the expert witness business is, psychiatric expertise in particular? The reality of forensic expert work is that each side hires its hired guns to say what they need to have said.

So Dr. Schouten, when did you stop beating your wife?

SCHOUTEN: Yeah, exactly.

(LAUGHTER)

SCHOUTEN: Well, thanks. It's actually - Dee makes a very good point. You can certainly find people who will say just about anything. Now, in fairness, it's sort of a bootstrapping argument because neither side is going to put someone on the stand who doesn't agree with their point of view. So is it that they shop around to find someone, in some cases, you know, who will agree with them? In some cases, that's the case. But people - it's a difficult field. It's hard to pin these things down.

And we hope that people will fulfill their obligation to be as objective and scientific about these issues as possible. The case I mentioned before where the fellow killed his mother up here in Massachusetts, I actually started out as the prosecution witness in that case and concluded that the fellow was severely mentally ill at the time and not criminally responsible. And I ended up not testifying as an expert for the prosecution but being called as a fact witness for the defense.

CONAN: When insanity pleas do succeed, is it not the fact that often experts on both sides agree?

SILVER: That's absolutely the case. The way it works out is, you know, upwards of three-quarters of successful not-guilty-by-reason-of-insanity cases are where the prosecution and the defense agree. There's no trial at all. And that just - that's the vast majority of the cases. So, although I'm sure Dee has basis for what he's saying, and I'm sure lots of lawyers and forensic psychiatrists have sort of anecdotal evidence, the data shows that it's usually raised in a case where the defense and prosecution are probably going to come to the same conclusion.

SCHOUTEN: And I would just go back one more thing for Dee is the comment that we're always mindful of malingering in these cases and the possibility that someone is trying to feign mental illness either to indicate that they're not competent to stand trial or to pursue an insanity defense.

CONAN: A friend who's covering the case emailed us to say she heard an interesting thing from a former D.A. out here that the goal of an insanity plea isn't necessarily to win a trial but to lay the foundations for mitigating factors when the jury has to weigh whether to impose the death penalty. Is that, Jim Silver, something you would consider as a defense attorney?

SILVER: Absolutely. I mean, I've actually heard already some experts saying something that I sort of find pretty believable, that this is sort of a slow-motion death penalty case right now. And by that, meaning that probably he's going to be found guilty and probably they will have asked for the death penalty. And probably what this really is going to come down to is, do we put him to death? And again, assuming he's convicted and assuming the state asks for the death penalty, that, you know, the mitigating factors that are successful when people are not given the death penalty are often related to mental health issues. So I agree. We're - the defense is probably looking forward at least in part to the sentencing phase in a death penalty case.

CONAN: Jim Silver, former federal prosecutor, current defense attorney. Also with us, Dr. Ronald Schouten, associate professor of psychiatry at Harvard Medical School. You're listening to TALK OF THE NATION from NPR News. And Paul is on the line, calling us from Boulder, Colorado.

PAUL: Yes. I am a former prosecutor. I've spent two years in the D.A.'s office in New Orleans and three years prosecuting in the parish of St. Bernard. And I also spent three years as a public defender in Orleans Parish. I frankly don't think that you ought to ever lose a not-guilty-by-reason-of-insanity if you handle it right. I mean, frankly, the way to do it is, like you said, like one of your experts said, you immediately get your client examined by your psychiatrist and assuming that the psychiatrist finds that your client is insane, you don't plead not guilty by reason of insanity right away.

You plead not guilty. You do everything you can to delay the case as long as possible. And then after you delay the case as long as you can and when you've got your feet to the fire and they're getting ready to pick the jury, you withdraw your not guilty plea. You plead not guilty by reason of insanity. The state has to ask for another continuance. They finally get another psychiatrist to take a look at him. And even if they find him sane, that psychiatrist on the stand has to admit that he hadn't seen the guy since - till two years after the event, and he can't say how he was then and that the psychiatrist who did see him immediately afterwards is at a much better position to understand where he was at that time. And if that's not a reasonable doubt, what is?

CONAN: Who wants to take that one?

SILVER: Well, this is Jim Silver. I'll take a crack at that. First of all, I think that's a well-stated strategy that might appeal to a lot of defense attorneys and probably gets used a lot. But I think one thing is important to remember, what Paul was talking about was sort of the battle of the experts, which is what we sort of see in dramas and we see in TV. In fact, the jury is going to be looking at a lot of other stuff independent of anything a forensic psychiatrist says. They're going to be looking at things like was this guy paying his bills, did he have a job, was he in classes.

All of these other things that they are going to take in to that jury room and say, huh? Leaving aside the experts and leaving aside this - the definition we've got, this instruction from the judge, which is probably very confusing, you know, does this guy know what he's doing? And they're going to look at some really practical stuff. So in terms of the experts, I agree with what Paul is saying, but the truth is a lot of these cases come down to lots of other sort of practical historical facts about the defendant that really aren't related to the expert testimony in court.

SCHOUTEN: You know, and the bottom line is regardless of what specific legal standard is used in that - in a given jurisdiction for the insanity defense, what it comes down to is whether the jury believes that the person suffers from some condition that requires them to decide that a person is not morally responsible for their behavior.

SILVER: And just one more point for Paul, up here in Boston, we had this Clark Rockefeller kidnapping trial. It was, you know, well-covered, and it was a mental health defense. The prosecution's expert got up on stand - a very eminent psychiatrist - and did a great job in his examination, but in turns out in court, he didn't know the definition of legal insanity in Massachusetts. And so he was giving this testimony and didn't even really understand what the standard was. Didn't really bother the jury. They convicted Clark Rockefeller. So even though the defense experts were very clear about his mental health issues and the prosecution seemingly less so, the jury didn't really buy it, and they convicted him.

PAUL: Well, I think it's - may I respond to that?

CONAN: Very quickly, 'cause we're running out of time.

PAUL: I think it's easier for the jury to have that feeling when you're talking about one single event. But when you've got a case like the one in Colorado where the guy is already under the care of a mental health professional, and he's killing people that he doesn't know and he doesn't have a motive against it, it seems to me it's pretty easy stuff.

CONAN: Well, we don't know what he's telling those people, but thanks anyway, Paul. It's very interesting stuff. Appreciate it.

PAUL: Cool. OK, cool.

CONAN: And our thanks as well to Dr. Ronald Schouten at Harvard Medical School. He joined us from the studio on the campus there in Cambridge along with his co-author Jim Silver. Their book, "Almost a Psychopath: Do I (or Does Someone I Know) Have a Problem with Manipulation and Lack of Empathy?" Thanks very much, gentlemen.

SCHOUTEN: We appreciate it. Thank you.

SILVER: You're welcome, Neal.

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