The Book Club

Everyone’s an Expert

Dear Chris–

Well … I don’t think there’s anything wrong with a psychiatric orientation, per se, or a therapeutic interview style, if that’s what works. Bell’s story does have a psychiatric dimension. And though Sereny may make bedwetting as a sign of impending violence sound silly, when it’s found in conjunction with other symptoms (arson and cruelty to animals), it is one third of the major red-flag triad of childhood disturbance. That these last two would be signs of trouble may seem like common sense. And there is obviously a difference between the enuretic child who also plays with firecrackers in July and throws small rocks at Mr. and Mrs. Nextdoor’s mean old cat, which probably calls for a lecture on safety and consideration, and the enuretic child who also plays with firecrackers by introducing them into the orifices of Mr. and Mrs. Nextdoor’s mean old cat, which probably calls for a long, close–and why not professionally trained?–look. For teachers and social-service workers to know what to look for and to look for it is not, in my opinion, surveillance, nor does it lead to Stalinism. For parents, or really, for anybody to know what to look for is not a bad idea, in my opinion. I am speaking from casual knowledge, not expertise (about the bedwetting, that is; I do have expertise in the area of my own opinions). I don’t even really know at what age bedwetting gets to be abnormal. But if I were writing a crusading book that dealt with the forensic psychology of a bedwetter, who at one point was observed choking a cat, and who destroyed property, even if not by arson, like say, Mary Bell, I would damn well look into it and spread the word.

Of course, psychiatry, like any other field, is subject to changes in fashion. In The Case of Mary Bell, her 1972 book, Sereny accepts more or less without examination the trial’s description of Bell as having a psychopathic personality disorder, and describes her allegations of sexual abuse by a teacher at her reform school as fantasy. In Cries Unheard, she rejects the psychopathic personality disorder assessment and describes the sexual abuse as having probably occurred. Sexual abuse is, of course, now a more generally accepted reality than it was in 1972. (Also not an omen of incipient Stalinism, I am prepared to argue.) Whether the turnaround on Bell’s psychopathy is similarly aligned with prevailing views then and now, I don’t know. I know there is a school of thought, maybe the mainstream one, that holds that children cannot really be diagnosed with personality disorders, because their personalities are not yet sufficiently … ordered. The formal diagnosis of Antisocial Personality Disorder, which is what the current Diagnostic and Statistical Manual of Mental Disorders calls what is also called psychopathic and sociopathic behavior, requires that the disordered personality belong to someone over 18. Before that, it’s Conduct Disorder, I believe. I again speak from casual knowledge, possibly casual ignorance. But if I were writing a book about someone who once met the common criteria for these diagnoses (violent, deceitful, etc.) and my contention was that she no longer did–someone like, say, Mary Bell– I would look into this aspect of childhood pathology too, even if I had to admit to having been less than all-seeing and all-knowing in 1972.

The thing about psychiatry is that everyone thinks he or she is an expert in human behavior, and therefore feels no need to adduce evidence to support their airy theses. Because I said so, that’s why.