WHY ARE PSYCHOPATHS RUINING AND RULING OUR LIVES

I am not only a psychiatrist, but I am also the son of a psychiatrist, the husband of a psychiatric 

social worker and the son-in-law of both a psychologist and a marital and family therapist. I 

have no off switch. A friend asked me recently, “Do you ever have just a normal conversation?". 

“You ask such probing questions; can’t you just have a normal conversation where you are not 

analyzing me?”. It is with this mindset that I decided to write a guide of psychiatry targeted for 

the general public. And it was with this mindset that I set about the task of writing specifically 

about what I have learned in my 20 years of experience working for the United States 

Government at County, State, and Federal levels.

Our country is mentally ill, and its illness is now so self-evident that it seems like a cliché to 

point out that America needs a psychiatrist.

You cannot fix a problem until you can understand what it is. This is no less true in psychiatry 

than in any other field of medicine. I was quite surprised, once I figured out the problem, to 

discover that there was nobody else in a Google Search who had come to the same conclusion. 

Later I learned from a colleague, that in fact there is an extensive body of literature that came to 

the same conclusion, but that even that body of research did not understand “why” such a 

problem existed. What has created our crazy broken country? What has gone so terribly 

wrong? It is unique to psychology in general, but one of the nice things about my field of 

expertise is that simple “awareness” is often the most powerful medicine.

What is The Problem: We have too many psychopaths in positions of authority.

Where are the psychopaths: They are at the top of hierarchies. They are leaders, managers, 

bosses; they are given power by their titles over the lives of their subordinates. They are found 

particularly in government and in the field most touched by government outside of it directly: 

health care. The three fields in which psychopaths rule more than they should are: Government 

Lawyers, Law Enforcement and Health Care.

Why are they there: We have demanded they do the impossible. It is the same as ordering a 

soldier that you want them to march to the left and to march to the right simultaneously. An 

honest soldier would tell you that it is impossible; you can have one or the other direction, but 

not both at the same time. Only a psychopath would tell you “OK, I can do that” and then lie to 

you when you ask, telling you what you want to hear. “Are you marching Left?”, yes, “And are 

you marching Right?”, yes. Ok, good job.

The three identified fields where psychopaths are most prevalent are given similar directions to 

this “march left, march right, now go” illustration. 

For example, for a Law Enforcement Officer the directions might be something like this: “We 

want you to keep the public safe at all times and we also want you to always treat every single 

bad person you meet with the utmost, care, respect, and unwavering concern for personal 

dignity. Incidentally, we will videotape all your actions and choose the start and stop points at 

our discretion and then judge you.” 

In Healthcare, it might be: “A human life is of infinite value, spare no expense caring for the sick. 

Also, do not spend too much doing something to help people as we need to cut costs.” Another 

healthcare issue is at the heart of much that is wrong with our nation. We rely on data without 

thinking about how the data can be misused. Health care providers are ordered to make sure 

their patients rate them highly on their evaluations of their performance even as they are asked 

by many of these same patients to fill out paperwork for questionable disability claims or 

controlled substance prescriptions. Many patients nowadays self-diagnose and self-prescribe 

before they ever come into the office using Dr. Google. They come in asking for a diagnosis of 

“ADHD” and requesting “amphetamines” or with a diagnosis of “PTSD” even though the trauma 

is in their imagination, they are paranoid or bipolar, and are requesting a Marijuana 

prescription. Anyone who thinks these mistakes are not at the heart of our mental health 

disaster is in denial.

In Government Law, it might be “You are an officer of the court and need to do the right thing, 

especially as a representative of the government. AND You will not have the resources or time 

to do a reasonable investigation. The government messes up a lot so we basically always try to 

protect government actions and actors no matter what. Most of the cases are bullshit anyway 

and we don’t have time to sort them out” (This always reminded me of a United States Marine 

Corps T Shirt, “Kill Em All. Let God Sort Em Out”). 

Now that I have identified the what, where, and why of the problem, I will explain the 

psychological phenomenon propelling it.

Terminology.

As much as I hate to do it, some terminology is necessary to make this model a valid piece of 

writing that others can build on.

These conflicting orders to government lawyers, law enforcement agencies, and health care 

providers create what is known as a “double bind”. There is no way out of such a situation as 

either marching left or marching right disobeys the contradictory order. I call such conflicting 

orders, on an agency level, “conflicting mission statements”. Agencies are told on paper and 

explicitly to do things they cannot do, and then their task shifts from completing an actual 

mission to APPEARING to complete an actual mission. To make the unreasonable SEEM 

reasonable. This always involves deceit.

Why are Psychopaths ruining our lives?

What kind of person can run a health care clinic nowadays? Often, they are not at all motivated 

by quality of care but only by their needs for power, money and prestige. They care only about 

the perception of the quality of care, not the reality. As one psychopath put it beautifully to a 

subordinate who was trying to tell the truth, “MY perception is YOUR reality”. Or as another 

leader put it, “Manny, it’s [healthcare] a business”. A leader in such a situation depends on 

maximum one-way obedience which is called “loyalty” and when that is not forthcoming uses 

the branding “insubordinate” and the recruitment of the lawyers begins to get rid of the 

“problem employee”.

So the person must be ruthless. It is not a simple matter to get rid of an honest employee, it 

requires some skill at crafting believable lies about that individual, and then implementing them 

which often involves intentionally creating double binds and then forging seemingly honest 

documentation of the lies you make up. It requires a lack of conscience, a lack of remorse, a 

lack of fear of getting caught, a disregard to laws and a willingness to gleefully commit “perjury” 

as long as you are reasonably sure you won’t get caught doing it, a willingness to bully other 

subordinates or build alliances with other sociopathic colleagues to gang up on the victim. As 

one psychopathic manager tellingly revealed with a smile, “There is safety in numbers”. Finally,

it requires the ability to instill fear in others with credible threats of harm. Psychopaths are 

known to have this ability and, in fact, in treating one it is often diagnostic.

MORE TERMINOLOGY (SORRY)

Narcissism is often misunderstood. It involves a self-deception as much as it does a deception 

of others. The self-deception is of one’s true self. Who am I really? The narcissist believes that 

they are better than they really are. In other words, they have a grandiose sense of themselves 

or a grandiose self. They believe their own bullshit. The worst thing you can ever say to a 

narcissist is “Who do you think you are?”.

Since they believe this, they constantly have conflicts that they have to mischaracterize as a

result of other people doing bad things. They are always the innocent victim. They are not the 

aggressor punching out, but always punching back.

In such folks there is a gap that exists, a huge space, between their grandiose self-perception 

and reality. If someone points out that gap -- that the emperor has no clothes -- it hurts the 

narcissist’s fragile sense of personal self-worth and security. In response, the narcissist protects 

their fragile perception by attacking the threat.

This gap is also true in organizations-I have called it the “Organizational Gap of Narcissistic 

Vulnerability”. This organizational gap exists because agencies with conflicted mission 

statements must present to the general public that they are doing their impossible jobs well. 

That they are their grandiose selves and that those who attack them are doing so out of their 

own badness. This explains why someone can insist that “The border is secure”, or that “All our 

agents are hardworking and doing good” when the reality is different. What kind of person can 

run such an organization? A psychopath.

The base of this model is that to fill that vacuum, to run the agency as if it is doing what it 

cannot do, inherently requires a psychopath. This is one of the key original insights of my 

model. It explains why so many Americans who have worked in government, or have been 

patients in large systems of care, or who have worked as health care providers in said systems, 

refer to them as “broken”, or as “a mill”. The implication being that the only consideration is 

keeping the mill running without regard to the quality of the product that it is churning out at 

high volume.

More on Why:

It helps to like your work.

To make the sausage. To run the mill. Specifically, to abuse honest employees and fire those 

that won’t be cowered, to lie and break the law, to do so with foresight and a lack of anxiety 

about getting caught, and to do so with malice. It helps to like your work and in my experience 

the job satisfaction of psychopaths in power is quite high. Since they enjoy the process of 

injuring others, having many victims they can prey on without getting caught, they love their 

work. They also make good money and get promoted easily, making more as time goes on.

A final common thread of the three agencies-- Law, Law Enforcement, and Health Care-- is that 

they all deal with psychopaths in society at large. Frivolous lawsuits, criminals, malingerers and 

drug addicts are a big chunk of the caseload of what these agencies are forced to deal with. The 

reality is that often one must do what is necessary to deal with such folks, even to just basically 

protect one’s self reasonably from harm or personal attack. As Larry McMurtrey once wrote, 

“Send a killer to catch a killer”. This means that the Organizational Gap Of Narcissistic 

Vulnerability is to some degree always unfixable, and should be baked into our reasonable 

expectations of the government and society.

The Model

At this point the structural model of what I am proposing should be clear. We have hierarchies. 

The hierarchies are of government-influenced agencies. These hierarchies deal with 

psychopaths in society at large, the agencies deal with life and death issues, and they all have 

conflicted mission statements. This creates a vacuum of need at the top of these hierarchies. 

Somewhere, they all need psychopaths to do the dirty work. 

The Intellectual Why: 

In my opinion, this is due to the death and split of psychodynamic and psychobiological 

psychiatry. We have forgotten how to understand human psychology in terms of drives, 

personal history, and internal conflicts, in combination with neurotransmitters and structures of 

the brain. Every patient is given a label and a pill, often with zero understanding of what is truly 

wrong with them and even less of an understanding of who they are as individuals. I foresaw 

this in 1988 and wrote about in two letters to the Editor of The American Journal of Psychiatry. 

Sadly, everything I predicted has come to pass exactly as I could see it emerging back then.

The Cultural Why:

The toxicity of cancel culture. Cancel culture means that if you have any imperfection in your 

being, it becomes like the drop of ink that spoils the glass of water. Of course, all human beings 

are drowning in ink the older they get. We all make mistakes, and would all be cancelled if held 

up to this standard. As Pete Buttigeg once said, “We have to be careful not to hold up purity 

standards that we ourselves can not pass”. But digital footprints of emails and social media 

have made this impossible as they are an eternal preservation of our foibles. The older ones 

have no digital records at all as there was no email (etc) and they never adopted it. The 

younger ones are ruthless enough to bury it and to bury anyone who dares try to expose it. In 

summary, we have made the perfect the enemy of the good, and are left with psychopaths as a 

result.

The Political Why: Federalist Papers

Our elected officials are ultimately the ones that charge the Agencies with their missions and 

craft legislation telling them what to do. Few understand this element of the Federalist Papers 

that then imbue such agencies with enormous power to destroy. As one manager put it 

succinctly, “We are the government, we can do whatever the fuck we want”. They can do a lot 

of damage without going through any kind of legal process.

But the designers also thought of a system of checks and balances whereby different branches 

and agencies would oversee each other. However, due to the lack of term limits and natural 

human tendencies, the separation has deteriorated, and nobody is watching the watchmen. 

They are both on the same side -- “the government” -- and they develop friendships, alliances,

and other connections so that they see themselves as collaborators against the troublemakers 

rather than truly independent fact finders. This is actually the end of the model which I call 

“The Stalemate”. The agencies cannot be purged of the psychopaths who dominate them and 

yet the psychopaths generally are confined to their Agency and its own unique series or rules, 

norms, relationships and corruption. There is no expansion or contraction.

The name for the model that I like is universally unpopular and is based on the Komodo Dragon. 

The Komodo Dragon kills all the other animals it wants to and yet it itself can not be killed. If it 

strays from its Island it can lose to another predator, but as long as it stays on its island, it is the 

top, the boss, the “Apex Predator”. I call this model the “Apex Predator Hierarchy Stalemate”. 

Hopefully by now gentle reader, you understand why.

The Fix

1. Awareness- Educate the field and the public of the new model

2. Survey Agencies- Using anonymity and AI this should be easy

3. Non-punitively address the personnel issues and force a change in mission statements to 

non-contradictory reality-based ones.

4. Restore separations between agencies that are supposed to police each other, or eliminate them entirely so there is no illusion of review