Galvanized into investigating the nature of psychopathy after a few strange encounters, Ronson interviews psychologists and psychopaths from all over the world to understand better what psychopathy is and isn’t. Psychopaths constitute just one percent of society, but the ways they impact our daily lives are myriad.

Ronson’s journey into the madness industry began with a curious case into which he was asked to bring his investigative journalism skills. A psychologist from the University College London Institute of Neurology met with him in a café in Central London and showed him a beautifully crafted book she’d received in the mail. The book was titled, Being or Nothingness, possibly a nod to Jean-Paul Sartre’s essay Being and Nothingness. The author was simply “Joe K,” a reference to the character from a Franz Kafka story, they surmised. The cover art was a picture of two disembodied hands drawing each other, one of the Dutch artist M.C. Escher’s famous sketches. On the back of the book was a sticker: “Warning! Please study the letter to Professor Hofstadter before you read the book. Good luck!” Written on the package postmarked Gothenburg, Sweden, was a note that simply said, “Will tell you more when I return!”

Who will be returning? When will that be? Who is Joe K? What does this have to do with the renowned polymath and award-winning writer Douglas Hofstadter? What is going on?

These were the questions that confronted the bewildered neurologist who approached Ronson—and not just her, but scores of intellectuals around the world. An astrophysicist in Tibet, a religious studies scholar in Iran, and a host of others had received the same gift with the same puzzling clues. They had found each other on the internet and formed a group trying to crack the enigma that, for some reason, had brought them together.

So what was the missing key to unlock the mystery? There was none. A collection of bright, rational academics assumed that there must be some rational explanation, some deeper meaning, but there wasn’t. It turned out to be a wild goose chase that a prestigious (and neurotically eccentric) Swedish psychiatrist and academic had concocted. Ronson got in touch with Professor Douglas Hofstadter, who was referenced in the book. Hofstadter informed him that he was just as confused and had received numerous copies of the same book with the same message, but that it had been written and translated by some crackpot Swede. There was no deeper message to be discerned.

Ronson managed to track down the man in Sweden. His face lit up when Ronson brought up the book, but he just as swiftly buried his elation under a mask of pleasant aloofness. 

When Ronson reported his findings to his neurologist friend in London, she seemed disappointed. But Ronson was struck by how much the doings of one crazy person had diverted the time, energy, and financial resources of a whole group of elite scholars that spanned the world. The man’s actions had activated the paranoia and narcissism in a group of scholars, catalyzed a flurry of theorizing, and got them curious enough to hire an investigative journalist.

Could it be that insanity’s influence on society is much more pervasive that we tend to think?

The Citizens Commission on Human Rights is an organization affiliated with Scientology whose mission is to expose abuses in the field of mental health. Scientologists maintain that, in addition to being the smartest person in the world (move over Moses, Jesus, Buddha, et al), their founder L. Ron Hubbard was on to psychologists and the destructive demonic energy they’d built up over thousands of lifetimes to destroy him and his work. His followers argue that he was onto the CIA’s MK-ULTRA mind-control projects years before the mainstream press broke the story. The Citizens Commission on Human Rights was Hubbard’s response to the evil “Antisocial Personality” rampant in the mental health industry, and he wanted to see the reputation of every psychiatrist besmirched.

Ronson met with a representative from the CCHR, and asked for proof that psychiatry and the mental health industry were as toxic as Hubbard claimed. The representative, Brian, immediately thought of Tony, who was a sane man being held in the Broadmoor psychiatric hospital. The CCHR was helping sponsor Tony’s case in the tribunals. Brian offered Ronson the opportunity to meet Tony, and, despite the strict security measures in places like Broadmoor, the meeting was easy to arrange.

Tony walked up with a winning smile, outstretched hand, and a snappy pin-stripe suit. The other inmates meeting their family and friends in the same room looked like doped-up slobs comparatively. Most wore sweat pants and casual wear, and scarfed down chocolate bars from the vending machine.  

Tony explained that he’d faked insanity hoping to escape a five to seven year sentence for GBH (“Grievous Bodily Harm”). When he was 17, he had beaten a homeless man senseless who was mouthing off to one of his friends. Borrowing lines and themes from every psychological thriller and horror flick he could, he cast himself as insane in hopes of being redirected to a small, comfortable hospital with cable and video games. Tony realized his escape plan was not panning out when he ended up at the Broadmoor instead. Twelve years later, he was still stuck in the Dangerous and Severe Personality Disorder unit of the Broadmoor, unable to convince his captors that it had all been a ruse to evade prison.

Tony concluded that it is far easier to convince people of your insanity than of your sanity. The harder you try to present yourself as a sane person, the more insane you look. You get self-conscious when you know that everything you say and do is being evaluated. Being normal and polite told clinicians that Tony could only behave well in a hospital setting, and it proved he was insane. He was kind and cheerful, which proved that the hospital was keeping his mental state from slipping any further. When that didn’t work, he stayed in his room. He didn’t want to spend his time befriending pedophiles and rapists—a perfectly sensible position outside the hospital—but inside it was interpreted as dangerously antisocial behavior. You’re crazy for not wanting to hang out with such people. Because the hospital can’t legally detain someone without treating them, he resisted any attempts by hospital staff to have even small conversations, in the hopes that they would release him. But these actions proved to the hospital staff that Tony was devious and manipulative. His attempts to prove his sanity only confirmed his insanity, as far as the hospital staff was concerned. One of Tony’s musings toward the end of the chat was that the whole ordeal was enough to make someone go insane.

When Ronson relayed his exchange with Tony to seasoned clinicians specializing in psychopathy, he was surprised to find that each psychologist emphatically confirmed the judgments of the Broadmoor staff. Tony was a textbook psychopath. He checked so many of the boxes on the industry’s evaluative standards: grandiose sense of self, tendency toward boredom, charm, lack of remorse, and so on. After such a lively, humorous exchange with Tony, Ronson felt torn: torn between a liking for Tony and a growing uneasiness that the clinicians may be right.

The 1960s was an era full of experimentation, and the field of psychology was no exception. One of the most daring and unconventional movements was nude psychotherapy. Its founder was Paul Bindrim, a psychotherapist based in Palm Springs, California. He facilitated nude group therapy sessions for celebrities and open-minded clients—usually upper-middle-class and educated. The idea was that the physical vulnerability would beget emotional vulnerability. They would sit naked in a circle and hum before screaming and weeping and divulging to one another their deepest fears. Bindrim would instruct strangers to pair up and gently hold each other, to hug or even wrestle. The goal was to break down any barriers or stigma that built up around those private parts humans have been conditioned to feel shame about. Even among enthusiasts of the human potential movement, this was fringe.

But not for Elliott Barker. Barker saw merit in the basic contours of nude psychotherapy, and sought to implement aspects of it among psychopaths at Oak Ridge hospital in Ontario, Canada. He believed that those considered psychopaths had managed to obscure their insanity beneath layers of “ordinary” behavior, and that if the insanity  could be gently coaxed to the surface, expressed, and dealt with, these psychopaths would emerge genuinely empathetic people. Barker obtained permission from the Canadian government to acquire massive amounts of LSD through a government-affiliated lab. He designed a Total Encounter Capsule, a small room painted bright green where prisoners would remove their clothes, sit together in their physical and emotional nakedness and help one another journey to the darkest corners of themselves and discuss the feelings that came up. No articles of clothing, no clocks, no TVs, just a constant conversation. Whatever the social constructs, this was the place where they were to be torn down and people be naked and unashamed. 

After the program was disbanded and a litany of lawsuits ensued, Barker now keeps a low profile, and even his colleagues were extremely unresponsive to Ronson’s emails—at least at first. They found his persistence endearing and eventually began to relay some of their impressions about Elliot, his work, and the work of his successor, Gary Maier, about whom they seemed considerably less enthused.

According to his colleagues, Elliot is kind and sincere and retains his idealism and desire to help people. Elliot had a knack for connecting with patients, and for a while, it seemed that the Total Encounter Capsule experience was generating some truly heartfelt encounters, that the prisoners were becoming more gentle and caring for one another. Some prisoners requested to stay in longer and continue the therapeutic work that they were engaging in. Barker saw these exchanges as signs of breakthrough. When he later stepped away from his work, he counted some of the psychopaths released from Oak Ridge among his dearest friends. A handful of them even worked with him on his farm and had meals with his family.

But when the results were in decades later, it came out that the experiments had made things worse rather than better, at least as far as recidivism rates. On average, 60 percent of psychopaths repeat offend and are sent back to prison. Among the psychopaths at Oak Ridge, that figure was 80 percent. It seemed the therapy had not made them empathetic as hoped—it had made them better fakers.

In 1975, there was a watershed moment for the study of psychopaths at a hotel in the Swiss Alps. Canadian psychologist Bob Hare invited 85 people from around the globe, each with experiences in the world of psychology and, more specifically, psychopathy. The aim of the meeting was to pool their insights gleaned through working with psychopaths and see what commonalities emerged. Were there any tells and tics that showed up across the board?

The result was a list of 20 items, now famously known as the Hare PCL-R Checklist.  For example:

Item 2 is a grandiose sense of self worth.

Item 3 is the need for stimulation/proneness to boredom.

Item 6 is a lack of remorse.

Item 8 is a lack of empathy.

Item 16 is failure to accept responsibility for own actions.

Item 20 is criminal versatility.

Hare’s Checklist has become the industry’s standard, and he has spent his life revising and detailing the test over the decades. Each of the items requires reading between the lines. You’re looking for key phrases and at the ways people put sentences together. When assessing someone for psychopathy, the clinician will assign a score of 0-2 for each of the items, a 0 signifying “does not at all apply” and a 2 meaning, “fits fairly well.” If a person scores 30 or higher, they are considered psychopathic. Tony at the Broadmoor hospital said he’d received scores of 29 or 30 whenever he’d been assessed.

Ronson joined Bob Hare’s conference in Wales, where Hare walked social workers, psychologists, prison guards, and profilers-in-training through his checklist and how to spot psychopathic tendencies. It was clear who the groupies and skeptics were, but by the end of the week, it was also clear that many of the skeptics who’d begun the week at the fringes with sullen expressions and arms folded had been converted by the end.

Two years after beginning his exploration of insanity, Ronson got another call from Tony—the man who faked his way into an insane asylum and couldn’t get out. The courts were reviewing his case for release from Broadmoor psychiatric hospital that day and he was hoping Ronson could be present. Ronson agreed to come.

Based upon the medical opinion of a number of psychologists, including the psychiatrists in the Dangerous and Severe Personality Disorder unit who spent the most time with Tony, the tribunal ruled that there were not sufficient medical grounds for continuing to hold Tony. The legal and bureaucratic mechanisms were to begin moving Tony toward release. After 14 years at Broadmoor, Tony would be free on a probationary basis in three month’s time.

Tony’s clinician Anthony Maden, as well the rest of the hospital’s staff, was delighted for Tony. Tony was right on the clinical threshold for psychopathy, and they agreed that it was wrong to continue holding him. Ronson asked if Tony could be considered a “semi-psychopath.” The idea resonated with Maden. He considered Hare’s approach to understanding psychopaths uncharitable.

Bob Hare’s general disposition toward psychopaths was often cold, but cold beyond the expected dispassion of a respected researcher. It sometimes seemed that psychopaths were a different species to him, that a single label had enveloped whoever failed his checklist. In the mental health industry more generally, there is sometimes a hastiness to arrive at a diagnosis and evaluate a person based on their most outlying verbals and nonverbals.

But could it be that as diagnoses are now increasingly common, abnormal is becoming the new normal? Half of Americans are diagnosed with mental illnesses, but with the DSM (Diagnostic and Statistical Manual of Mental Disorders) now almost 1,000 pages long (and growing), perhaps this should not come as such a shock.

In a conversation with Robert Hare, Hare mentioned off-handedly to Ronson that he wished he’d studied psychopaths at the stock exchange rather than in prisons. He reasoned that while the psychopaths in prison ruin families, psychopaths in corporate and political life can ruin economies and cultures. One percent of the general population are psychopaths, but that figure leaps to four percent among the powerful in business, political, and religious life.

But if there are semi-psychopaths out there, people who have some of the qualities of a psychopath and other qualities that are quite normal or even good, is it wise to use one part to envelop the other? Which “side” of a person should become the basis for evaluation?

Tony, for example, doesn’t take responsibility for his own actions, but that’s the case for many people outside of institutions as well. He can be a bit of a bully in some situations, but he’s not inflicting harm for its own sake. Moreover there are good things about Tony, too: his wit, his skill as a conversationalist. There are plenty of flaws and eccentricities that each of us has—regardless of how we score on Hare’s Checklist—and they make life varied and interesting. Perhaps one-word diagnoses and over-diagnosis can condition us to lose touch with the positive side of the existential ledger.