My name is Ross Dunne and I have the best job in medicine. I am a consultant psychiatrist for the over 65s working in one of the most diverse and disadvantaged areas of Britain – North West Manchester. I care for both inpatients and outpatients, and I deal with a range of illnesses including the “bread and butter” of psychiatry like depression and schizophrenia, but also dementia. The demands of these two aspects of the job are wildly different. This range of illness stretches my expertise from neurological examination to cross-cultural communication, from breaking bad news to the intricacies of psychopharmacology, and everything else in between.
Wednesday morning means home visits. This morning I was invited into the home of an Asian lady who has suffered a manic episode and needed to be admitted to our inpatient unit a few months ago. She recovered well and went home to her family. Now, as is so common in bipolar disorder, she has become profoundly depressed. When I last saw her, she was in despair. She was rocking in her chair, wringing her hands and chanting Qu’uranic suras alternating with obscure Punjabi phrases under her breath. Her son translated some of her utterances, which turned out to be iterations of and variations on “I’m so bad – I cannot help it, I am no good”. I was reminded that whether one is from the sleepiest corner of Rawalpindi, or darkest Kent, the depths of psychic pain are often extraordinarily similar.
Psychopaths are most often seen in the cinema, slaying and scheming, but some argue that those with psychopathic traits are more common than we may like to believe and, although many don’t go as far as committing crimes, their actions can still be immensely destructive to society.
Psycopathy is considered a personality disorder, and although no organisation of psychiatrists or psychologists has sanctioned the use of the term as a formal diagnosis, the word is widely used in criminology.
Psychologist Robert Hare created his ‘Psychopath checklist’ to quantify traits and characteristics which suggest an element of psychopathy in an individual. The traits he describes include a lack of empathy, shallow emotions, impulsivity and irresponsibility. Psychopaths tend to have early behaviour problems and be involved in juvenile crimes. They may have multiple, short-lived marital relationships and be known for being sexually promiscuous. They are pathological liars and have a grandiose sense of self-worth. Despite these traits, many of which society might conservatively consider amoral and unacceptable, psychopaths are extremely charming and are often high achievers. At this point, you may be looking at this list, reflecting, and panicking slightly. But, as Jon Ronson wisely points out in his book ‘The Psychopath Test’, if you are wondering if you are a psychopath, you possess enough self awareness to confidently say: no, you are not.
‘You know what, I might have OCD’, I think to myself as I descend from my attic room for the third time in an hour. It’s 1am. I know that all of the doors are locked – I’ve done this twice – but I just need to check once more, just in case. I’m also worried that I haven’t locked my car, but I can’t go out to make sure because if I do I might get stuck at the front door for ten more minutes. Before going back upstairs, I stand by the hobs for a while to ensure none of them are leaking gas. I’m so tired my eyes are stinging, but I know I can’t go to bed until I put my phone on charge and then stare at the alarms page until I’m satisfied it’s definitely been set. I head back upstairs, hopefully for the last time. You’d be forgiven for thinking my room had been burgled – it’s that messy. That’s normal. Usually, when I gaze upon my shambolic living space the question of whether or not I have OCD is swiftly dismissed. I tell myself not to be ridiculous; people with OCD have tidy bedrooms, right? Besides, there are some people who really suffer with it. ‘Don’t be disrespectful.’