Wrestling With Evil in the World, or Is It Something Else?

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

Over 13 years ago, on March 2010, I wrote an article for Psychiatric Times titled “Wrestling with Evil in Prison Psychiatry.” My writings on prison psychiatry actually won health care journalism recognition.

Having never before applied the word “evil” in psychiatry, I ended up doing so in regards to one patient. Nothing else seemed to apply, neither gang involvement, antisocial personality disorder, or his religious beliefs. At that time, for clinical applicability, I came up with this definition of evil:

“Evil is unacceptable, destructive behavior, exhibited without remorse and without a more general moral framework, which cannot be explained solely by psychopathology.”

The word is most often used in relationship to religious beliefs, and especially in situations that seem horrific. Since that prison encounter, I have come to conclude that any evil-seeming behavior is likely intertwined with whatever psychopathology may be present.

I feel a sense of deja vu as the Mideast and Ukrainian-Russian wars go on. Evil has been tossed back and forth as an explanation of the atrocities that have taken place in the invasions, but without explaining its genesis. Here, gang behavior seems as prominent as any other “evil” explanation.

Then there is the recent mass shooting in Maine, the only news to get the Mideast war off the front page of the mainstream news. Here, though, there seems to be a clearer psychiatric explanation, with the perpetrator having a history of auditory hallucinations. He spent 2 weeks in an inpatient facility this summer after apparently threatening a military facility, but more information will be required to understand the role of mental illness and its treatment in his crime.

Ultimately, almost by definition, human nature and human behavior seem to be at the genesis of any such violent horror. Freud wrote much about it, especially in his book Civilization and Its Discontents, even suggesting a death wish. Regardless of the need for better gun safety, it behooves us in psychiatry to try to increase our knowledge and interventions to reduce “evil.”

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry, and is now in retirement and refirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.