You’ve had a rough childhood. Your biological father skipped out before you were old enough to remember what an asshole he is. Your stepfather took every opportunity to embarrass and/or humiliate you while your mother stood by without saying a word.  

As a teenager, you’re involved in an automobile accident that results in a head injury; you have no permanent brain damage but develop seizures for years afterwards. You’ve always had mood swings but these have gotten a lot worse since your accident. You have no criminal record, but have choked your dog out of anger and, more and more, find yourself filled with rage over the slightest hint of rejection or conflict. Worse, you find yourself spending hours a day entertaining increasingly violent fantasies about raping and killing and are starting to develop some very specific plans.

This is the background of at least one budding serial killer. Fortunately, in the fascinating article I just finished, our 27-year-old patient didn’t let his fear of treatment overrule his aversion to homicide. This young man appeared at a psychiatric hospital declaring he was a “budding serial killer” and wanting help before his became one.

Serial killers: mad or bad?

 Mr. X had many of the traits associated with serial killers in the literature yet was dissimilar in many others. On the one hand, he shared the family background of many serial killers. He certainly shared  the obsessive homicidal fantasies and plans that preclude serial murder. He had also obtained a weapon.

On the other hand, Mr. X did not have the criminal history that that so often accompanies serial murder. He scored low on the Psychopathy Checklist-Revised and, unlike virtually every other serial killer, voluntarily presented for treatment. This lack of psychopathy may have led him to treatment rather than to carrying out the planned homicides. In addition, while many serial killers develop unusual thoughts, Mr. X ‘s thinking became increasingly bizarre, during which time he was transforming into a nonhuman.

He also had some other problems; a history of depression, substance abuse, and borderline personality disorder. While his complicated list of problems made his a challenge for treatment, it also suggested that mental illness—rather than psychopathy—was at the core of his homicidal fantasies.

Serial killer interrupted

Mr. X was in a psychiatric hospital for eight months even though he wanted to be discharged sooner. After a combination of medication, psychotherapy, substance abuse treatment and milieu therapy, Mr. X’s mood began to improve and he gained insight into the underlying dynamics of his homicidal fantasies, many of which were directed at people with whom he had had an unsatisfactory relationship. At four months post-discharge, he was doing well, living in a group home, and complying with treatment. He was also going to be followed by the courts for two years.

The bottom line

Type in “the urge to kill” on the internet and you’ll be amazed (and terrified) at the number of people who confess to these fantasies. Having read many of these, I’ve come to two conclusions; a) some of these are written down for their shock value, but b) some people who have these fantasies are afraid of them but even more afraid of getting help.

Most serial killers have violent fantasies for years before they act on them. For some, at least, these fantasies are disturbing and not consistent with how s/he wants to behave. 

So what do we do? How do we encourage those individuals to get help before they proceed down the path of no return? Given that many people struggling with mental illness don’t get help because they’re afraid of the stigma, how much more difficult it must be when there is the very real possibility that, once these homicidal fantasies are disclosed, that person may no longer have  total control over his destiny.

What do you think?

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