Mr. S was a loner, a middle-aged man, a former alcoholic who lived out of a van while caring for his frail mother. He had never married or dated, but drifted from two stints in the Army to security guard jobs, where by choice he always worked alone and at night.
He had only one real friend. They had lost touch.
After seeking treatment for depression, Mr. S confessed to his young, female therapist that he had also "followed, raped and killed numerous women" during the 20 years since leaving the military, where he had been a decorated war hero.
To his alarmed therapist, a new Journal of Forensic Science case report says, he reported he would follow women around for months before strangling them with rope he kept in his van, following the pattern of famous sexually sadistic serial killers he had read about.
He was stalking a woman he had seen at a library right now, he said.
“This doesn’t happen every day to therapists,” forensic psychiatrist Park Dietz, the senior author of the case report, told BuzzFeed News. “It’s always a surprise, unless you cultivate that kind of thing.”
Frightened and feeling threatened, the young therapist turned Mr. S's case over to her supervisor, who asked the police to investigate and saw him for a few sessions; their patient said he was even more depressed and was hearing voices in his head.
But he refused to reveal more about the woman he was following, or details of his crimes. And he also said he now wanted to kill his sergeant from the Army, who had mistreated him.
Finally, when Mr. S said he tried to amputate his own leg using a tourniquet, his (now) team of therapists sent him to the emergency room, where he was detained as a danger to himself, and to others.
“We don’t hospitalize people over their past claims of violence, but there was his report of an amputation attempt and stalking someone,” University of Southern California psychiatrist Christopher Fischer, the first author on the case report, told BuzzFeed News. “We can only hold someone for so long, though.”
Investigators tried to find the woman from the library, the sergeant, and the girlfriend of Mr. S’s one friend, whom he now reported he had also wanted to kill for taking away his pal. They asked police in the Pacific Northwest, where Mr. S was from, to look into his serial killings. And in the meantime, they asked a district attorney to keep their homicide-minded patient involuntarily hospitalized.
Mr. S seemed surprisingly happy, despite claims of “severe depression and psychosis, including a new symptom of hearing Italian opera” at night, according to the report. He was calm and cooperative, slept and ate well, seemed cheerful, and showed clear thinking during psychological tests. His antidepressant dose was was increased, and after two days, he reported he was happy again and that the opera singing had disappeared.
But none of his claims appeared to be true. Antidepressants take weeks to kick in. His military service was undistinguished. The police couldn’t link him to any unsolved murders (and even though he claimed he raped his victims, he didn’t report any sexual excitement over sadism, as is standard for serial killers). Psychological testing didn’t find any murderous tendencies in him, just narcissistic ones consistent with a borderline personality disorder, which is marked by impulsive actions, unstable relationships, and intense mood swings. They also make stuff up, Dietz said.
“Pretty much from the start, we were always a little suspicious. Part of the problem is that there are privacy issues and it takes law enforcement time to run things down,” Fischer said. “We ended up going on a wild-goose chase.”
At that point it was too late, and the request for six months of involuntary hospitalization had gone through a judge. “It was out of our hands,” Fischer said. “After we filed for the 180-day hold, he basically confessed he had made the whole thing up.”
Why? Because, he told the team, he “wanted attention.” He had never followed, raped, or killed anyone and didn’t want to, he said, but wanted to be “more interesting” to his original therapist, who was ending her scheduled stint as his shrink soon. So, Mr. S was basically committed to a psychiatric hospital for six months because he made up a story to impress a young woman. The problem was that it was a terrifying story.
“He apologized, seemed embarrassed, said he started saying these things and they took on a life of their own,” Fischer said. “What is unusual here is that he seemed unaware or unclear that his confessions would frighten anyone.”
In general, courts have recognized that psychiatrists have a legal obligation to warn potential victims of their dangerous patients since a 1976 court case in California ruled they have to "use reasonable care to protect the intended victim." But because this explicitly violates patient confidentiality, psychiatrists have to weigh in their judgment the seriousness of the threat, often a gray area, before alerting the police or a potential victim. Different state laws have created a patchwork of obligations on therapists, ranging from mandatory warnings in states such as California to no requirement in states such as Nevada and North Carolina.
Most cases of such a “factitious” mental disorder (sometimes known as Munchausen’s syndrome, named after the fictional Baron Munchausen, who told impossibly tall tales of his wartime adventures), involve patients claiming imaginary illnesses to garner sympathy from doctors or nurses, not violence. About 2% of all doctor’s visits might be such factitious disorders, according to the case report.
If the whole point is to garner sympathy, however, posing as a serial killer would seem like a bad choice. Unless perhaps you are trying to generate interest in someone interested in really messed-up psychology.
“Factitious disorder is a real mental illness,” said Fischer. “I think, for him, claiming to be a serial killer, like being a war hero, might have made him a more powerful, interesting, person in his mind.”
His case contains hints of the best-known pop culture depiction of a serial killer, the suave, superhuman Hannibal Lecter, from the Silence of the Lambs, who intrigues a young woman investigator even as he horrifies her, Fischer said.
“Almost every case of factitious disorder seems unusual,” University of Melbourne psychiatrist Richard Kanaan, who was not on the case report team, told BuzzFeed News. “The feigning of mental health problems is not uncommon in factitious disorder, nor is a fabricated glamorous backstory,” he added by email.
“And the patient is reported to have explained his action as an attempt to make himself appear more interesting to his therapist.”
In general, people with borderline personality disorder, Dietz said, “create drama and chaos around them, and they do that in a variety of ways that may be described as manipulative."
The most famous cases involving psychiatrists are ones where patients falsely claimed they had multiple personalities. A vogue for such cases flourished into the 1970s, creating a mini epidemic of dubious accounts. “What better way to interest a therapist?” Dietz asked.
“The actually interesting part of all this is that it reminds us once again that things are not always what they seem, and if a story sounds too good to be true, then it probably isn’t.”
Mr. S was awkward but perfectly friendly in the hospital, from which he was released after his six months were up. He had trouble relating to other people, Fischer said, but was never rude or unfriendly while confined. He never quite grasped, though, why his claims of being a sexually sadistic serial killer frightened his therapist.
“He was able to get help, because he couldn’t leave,” Fischer said. “That’s the real problem with treating factitious disorder. When you talk to people about it, they leave and go somewhere else for the sympathy they want.”
The team doesn’t know where Mr. S is now. “I would be very surprised if he had ever hurt anyone,” said Fischer. “He was very friendly on the ward. In fact, he was pleasant.”