03/30/2013 09:40 am ET Updated Dec 06, 2017

Who Can You Trust?

Click here to read an original op-ed from the TED speaker who inspired this post and watch the TEDTalk below.

Narcissism is normal if we don't get carried away with it.

A healthy self respect and expectation to be treated fairly is normal narcissism. It helps both children and adults weather challenge and misfortune; it is essential to resilience -- that wondrous quality that makes for bouncing back rather than giving up.

But some people just get carried away. They show such exaggerated narcissism we search for another word to describe them -- like psychopaths.

The indifference of psychopaths to others is striking. We are appalled by their greed. We are astounded by their behaviors which reveal a belief that rules are made for others, not them. While they may be entertaining on TV and movies, their close presence in our lives should have us checking to see if we still have our wallet. Their inflated sense of self may take them to high places but their stay there is tenuous and transitory. Those whom they lure into their grasp soon lose patience and forgiveness -- we can allow for honest mistakes but we tend to want redress with those who take us for fools. The infamous case of Bernie Madoff had Jon Stewart joke that when the Judge gave the convicted man a choice of 150 years in jail or walking free but unaccompanied out of the courthouse, Madoff chose the former.

One Scientologist told Ronson if he wanted to see how far out psychiatric diagnosis can go then he had a case for him. -- Lloyd I. Sederer, MD

Jon Ronson, a journalist and our TED speaker, became especially intrigued by psychopaths, in a rather circuitous way. When he came upon the Diagnostic Manual of Psychiatric Disorders, the DSM, as necessary as it is controversial, he promptly 'diagnosed' himself with a dozen disorders -- showing perhaps both his own fallibility as well as that of this bible of psychiatric diagnosis. That discovery led him to the mother church, so to speak, of the critics of psychiatric diagnosis, namely the Scientologists. One Scientologist told Ronson if he wanted to see how far out psychiatric diagnosis can go then he had a case for him.

Ronson then tells the tale of venturing from his hometown of London to a place not so far on the tube but very far from what he has ever experienced: Broadmoor Hospital, a long-term mental asylum that is a remnant of days past. There he meets Tony, a psychopath who thought he could elude punishment for assault by feigning madness. Boy did he make a mistake.

Tony had been in Broadmoor 12 long years! Far more than any sentence he might have copped. Maybe he also wasn't very intelligent? There is also a diagnosis for that. By the way, psychopaths in the U.S. rarely use the NGRI (Not Guilty By Reason of Insanity) defense because they know it will deliver more time inside than going to prison. Are our psychopaths smarter?

No matter what Tony did he couldn't find a way out of the hospital. Everything he said to his doctors seemed to be used against him to continue his involuntary hospitalization, he reported -- but what would you expect a psychopath to say? The opposite applies in this country where getting psychiatrically hospitalized is as difficult as remaining for more than a few days.

But our TEDTalker was captivated by Tony and his mental aberration, as psychopaths are known to be able to do. Ronson decides he wants to penetrate the ruling class of psychopaths, to his mind -- the corporate titans. He tries to visit Enron inmates but they won't bother with him. He finds Al Dunlop (Chainsaw Al) in Florida, renown for his neutron bomb tactics in decimating companies (read employees) in the 1990s. Ronson by then had trained in the HARE PCLR (a psychopathy checklist widely used among forensic experts that was developed by Robert Hare) so as he observes this titan he checks box after box in his mind. Everything Chainsaw Al said could be used against him too.

Ronson's tale is witty and highly engaging. His ending suggests that checklists and diagnostic manuals notwithstanding neither he -- or anyone else -- should spend time with a psychopath, perhaps aside from getting a story.

But isn't that what the PCLR and the DSM would have said?

Dr. Sederer's new book for families, The Family Guide to Mental Health Care, is available now for release on April 15.

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