Reviewed by Karen Hansen

Can a book about psychopaths be both appealing and chilling? Journalist and filmmaker Jon Ronson gives us jolting, addictive doses of frightening, disturbing practices and quirky, enigmatic characters in his new book, The Psychopath Test: A Journey Through the Madness Industry. In this nonfiction book that at times reads like a novel, Ronson takes a close look at psychopaths and the mental health professionals who treat them.

At the beginning of the book, Ronson muses: “I’ve always believed society to be a fundamentally rational thing, but what if it isn’t? What if it is built on insanity?” Stoked by curiosity about the diagnosis and treatment of psychopaths, Ronson embarks on a Don Quixote-like quest to understand the prevalence, treatment and validity of the disorder.

While unraveling the mystery of an anonymous manuscript sent to random academics, Ronson becomes intrigued by the influence of psychopaths on our society. While Charles Manson and David Berkowitz (a k a, Son of Sam) exhibited evident aberrant and antisocial behavior, Ronson’s thesis is that many overtly normal, even high-performing individuals exhibit psychopathic traits in subtle ways. According to Ronson, “Everyone in the field seemed to regard psychopaths in this same way: inhuman, relentlessly wicked forces, whirlwinds of malevolence, forever harming society but impossible to identify unless you’re trained in the subtle art of spotting them.”

Ronson, the author of Them: Adventures With Extremists and The Men Who Stare at Goats, is a writer who is drawn to the bizarre and unorthodox. A skillful interviewer, he never acts condescending toward his interview subjects. People warm to him and they like talking to him. He is equally comfortable interviewing a former Haitian death squad leader and a cross-dressing conspiracy theorist with a messianic complex. Ronson interviews patients and mental health professionals, and also researches the diagnosis and treatment of various psychiatric illnesses as he attempts to learn about the influence of psychopaths. His findings are structured into a series of absorbing, interrelated nonfiction stories that astonish as much as they inform.

To become familiar with critical views of psychiatry, Ronson interviews Brian, a member of the Citizens Commission on Human Rights, an arm of Scientology charged with exposing the evils of psychiatrists and psychiatry. Brian wants Ronson to meet “Tony” as “proof that psychiatrists are nuts and they don’t know what they’re talking about and they make it up as they go along.” Tony feigned mental illness to avoid a prison sentence for the brutal beating of a homeless man; he has spent more than 10 years in a psychiatric hospital and cannot convince officials that he is sane. When Ronson learns that Tony has been diagnosed a psychopath, he becomes wary of Tony and Brian as he recalls the words of Dr. Essi Viding, a psychologist who studies psychopaths: “Psychopaths don’t change.  … They don’t learn from punishment … the real trouble starts when one makes it big in mainstream society.”

Ronson learns the behavioral characteristics of psychopaths — such as lack of empathy, lack of remorse or guilt, pathological lying and grandiose sense of self-worth — in a seminar given by Dr. Robert Hare, the developer of the Hare Psychopathy Check List, a tool used to diagnose psychopaths. Hare suggests to Ronson that psychopaths are the root cause of many of the world’s problems.“Serial killers ruin families,” he postulates. “Corporate and political and religious psychopaths ruin economies. They ruin societies.”

Armed with his new “psychopath-spotting abilities,” Ronson attempts to smoke out psychopaths in business, politics and journalism. The stories Ronson gathers from these interviews beg the question: Are we all guilty of mad behavior? “Charlotte,” a television reality-show producer, admits she asked potential guests on her show to list their psychiatric medications because a certain kind of mental illness made good television.  Charlotte needed to assess if potential guests “were too mad to come onto the show or just mad enough.” After a guest on her show sliced open his wrists following a humiliating round of questions, Charlotte decided it was time to leave television.

Ronson’s odyssey leads him to examine the ethics and diagnostic skills of psychiatrists and other mental health professionals who treat psychopaths and others for psychiatric disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). He examines the uptick in cases of childhood bipolar disorder, questioning the validity of the diagnosis and safety of treating children with potent atypical antipsychotic drugs. Allen Frances, a psychiatrist who was editor of the DSM-IV, reflects that “psychiatric diagnoses are getting closer and closer to the boundary of normal” because “there’s a societal push for conformity in all ways.”

After laboring over histories of psychiatric treatments and interviewing mental health professionals and patients in Europe and the United States, Ronson concludes that while there are some people in our society who suffer from various forms of mental illness, “there are also people in the middle, getting overlabeled, becoming nothing more than a big splurge of madness in the minds of the people who benefit from it.”

The Psychopath Test is likely to be controversial. Consulting Scientologists about psychiatrists and psychiatry may bother some readers given the religion’s anti-psychiatry platform. In addition, some may object to the use of the term “psychopath,” a diagnosis not listed in the current version of the DSM-IV.

However, Ronson does not pretend The Psychopath Test is an academic or a scientific text. Ultimately, he provides a good read that jars us into thinking about psychiatric diagnoses and treatments. Ronson, a self-reflective writer, pushes us to consider our “maddest edges” and how they influence our society.

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Karen Hansen has written extensively on medical topics, including psychiatry, infectious diseases and women’s health. A former CBS News writer and associate producer, she co-authored the book Toward Understanding Children and has been a contributor to the annual anthology on performing arts published by the Library of Congress.