Why are we so fascinated with murder?

Originally published May 24, 2011.

The public is endlessly fascinated with murder.  When it’s on the news,  we may recoil in shock and horror,  but often and in other media,  homicide is a source of entertainment. We wonder why people kill and we are intrigued by the ways in which the deed is accomplished.

In the real world,  there is in fact a practical duty we share in understanding the means and the motivations for crime.  Understanding is necessary for prediction,  prevention and protection.

But the popular fascination with homicide goes far beyond the practical.  The story lines are a staple of art and literature and a subject for both drama and comedy.  The murder mystery is often most compelling when it abandons reality and is framed in fantasy.


For therapists: HIPAA Compliant Video Resource Review and Recommendations

Now is the time for health care practitioners of all stripes to get online with video conferencing capability. It is not difficult and may not be optional in the coming days.

The U.S. Department of Health and Human Services (HHS) has announced a suspension of the HIPAA Telehealth rules in response to the COVID-19 emergency.
The OCR (Office of Civil Rights) will not penalize "health care providers that serve patients through everyday communications technologies ...
This exercise of discretion applies to widely available communications apps, such as FaceTime or Skype, when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19."
In other words, for the time being, clinicians may use everyday video platforms without having a signed BAA (Business Associate Agreement).
However:  Public facing applications such as Facebook Live, Twitch, and TikTok "should not be used in the provision of telehealth by covered health care providers."
That being said, it appears from my research that a forward looking leap into this technology will land you on a platform with the HIPAA option available, which is probably where you need to be as telehealth becomes the new normal.

There are "hundreds of options" according to one reviewer. And it was not difficult to learn that  video is now a standard add-on for most all practice management systems on the market. So perhaps you should start there if you or your clinic uses such a system. But for ordinary practitioners ...

Simplicity is a virtue. 

The HHS list of "some of the vendors" is as follows:

  • Skype for Business
  • Updox
  • VSee
  • Zoom for Healthcare
  • Google G Suite Hangouts Meet
My web searching did not uncover any hidden gem not on the list. So, in a saving-the-best-for-last order ...

My Observations:

Skype for Business is part of the Microsoft Office ecosystem - obviously not a tool designed specifically for telehealth. The support pages were of no help with respect to clarifying how the HIPAA compliance is managed. A reviewer says that it depends on which package you pick.
Rating: Maybe this works for you if you are a Microsoft Office subscriber.
Cost: $12.50 per month (what you pay monthly for Office).

Google G Suite is for people who use G Suite, not your everyday Google. This is an enterprise solution for organizational communications (email+) with video-conferencing as an add-on. I've been inside G Suite - there is a learning curve.
Rating: Good for you if you already use G Suite and have a good system administrator.
Cost: $6.00 per month - free to nonprofits, education and government.

Updox has salespeople! You can "request a demo." Their target is any profession medically related. To learn more choose either "provider" or "pharmacy."
Rating: I prefer the details up front. 
Cost: Click button to "Request Pricing"

VSee is a slick product with a lot of bells and whistles for patient management and after-session record keeping. The website says: "VSee powers NASA Space Station." You can pop an X-ray or brain scan up on the screen to share with patients. It is the choice of one respected colleague/reviewer; another colleague complained that she had difficulties with it. VSee's list of products shows the "clinic" option as the entry point, and they are also promoting its use as a software development platform.
Rating: Great if you have big plans and like to wear a white coat.
Cost: $49.00 per month.

Zoom is the hot platform for video conferencing. You can start out for free and then move up the ladder from there. It's the choice of the schools in my neighborhood and my wife connects through Zoom to yoga class. Like Skype and Google, Zoom does not have a telehealth look or feel. But wait, there's more! It is not "Zoom" that was recommended by HHS, it was "Zoom for Healthcare," which does feel like a Doctor visit. For a signed BAA for HIPAA compliance, please contact sales "and learn about 1, 2 and 3 year pre-paid packages."
Rating: Great for your clinic or your community mental health system, or if you plan to host webinars and teleconferences in the future.
Cost for Zoom Healthcare:  $200.00 per month. is a mission-driven business that started with a grant to a university hoping to serve its community. From the ground up, it was intended for telehealth, with an emphasis on simplicity. Big selling point: patients do not have to download any app or install any extension - it runs in the browser, either Chrome or Firefox, and is mobile-friendly. was the winner in a Clemson University usability study (compared to VSee and two others). The paid version lets you "personalize your waiting room" (your picture and info) and use a custom url. Session history is automatically saved (time, date, duration). The free version does not access the best quality video, does not integrate text/e-mail notifications, and does not allow for groups. The BAA for HIPAA compliance is included in all packages, both free and paid for. There is a "clinic" option, but this is the only platform I looked at that had a button "for providers."
Rating: The packaging and the interface are easy on the eyes; the pricing is easy on the pocket book. Usability matters! Editor's Choice. 
Cost:  Free is Good; Better is just $35.00 per month, no contract.

One more thing! Training and education are always advised when clinicians start out doing new things. Beyond the technology, telehealth involves ethics, regulations and clinical concerns.

My recommendation (influenced by pre-existing collegial relationships with the instructor and CE provider) is for therapists to take the 2 hour online CE Telehealth 101 class at the Zur Institute:
"Clinical, Ethical and Legal Considerations of Online Psychotherapy."

As a follow-up, and for broader study, consider Dr. Zur's 8 hour course: Digital and Social Media Ethics for Therapists.

Copyright, Paul G. Mattiuzzi, Ph.D.


Hey, therapists! The time to act has come today. You must protect your patients and your practice!

Health care providers of all stripes need to be communicating with clients and patients now. Today is Friday the 13th, and everyone following the news knows that we are about to experience significant disruptions in the normal social order due to the COVID-19 novel coronavirus.

As practitioners, your immediate task is to let your patients know if there is any active disruption in the normal operation of your office and what specific steps you have taken to insure hygiene in the office. And don't forget ventilation!

Start Here: COVID-19 and psychology services: How to protect your patients and your practice ... from the American Psychological Association

Further study: Pandemic News, Tips and Tools from the APA ... includes resources such as the World Health Organization's "Getting Your Workplace Ready for COVID-19" brochure.

Be Aware: This is a time of necessary social isolation and heightened social anxiety. There will be casualties. The psychological toll that will follow the economic disruption will be significant. The number of people without resources to weather this storm is substantial.

Next Steps: It may become necessary for you to self-quarantine while symptom free and still able to serve clients. In next week or so, you may very much need to have video conferencing capability. (I am looking into the options and will share what I learn fairly soon).

For now, from the National Register:

Copyright, Paul G. Mattiuzzi, Ph.D.


Donald Trump, Insanity, and the Law of Subjective Moral Precepts

If Donald Trump decides to plead insanity in some future criminal proceeding, all the talk about him having a mental disorder is certain to come to an abrupt end. Everyone will say: “he’s not crazy, he knew what he was doing … he can’t get off on that.

For Trump, an insanity plea would not be an irrational defense strategy. The person third in line for Presidential succession, Speaker Nancy Pelosi has already said that in her opinion, the President “does not know right from wrong.She also expressed compassion regarding his condition: “it's a very sad thing."

A criminal defendant can be found insane if as a result of mental disorder, they lacked the capacity to know the nature and quality of their act or if they lacked the capacity to distinguish right from wrong. 

Drummond mortally wounded by M'Naughten,
as dramatized by PBS Masterpiece 'Victoria'
Some form of this two-pronged insanity test (“did you know what you were doing and did you know it was wrong?”) is the law in most all U.S. jurisdictions, and is known as the “M’Naughten rule.” 

In 1843, Daniel M’Naughten shot and killed Edward Drummond, private secretary to British Prime Minister Robert Peel. At trial, it was said that M’Naughten labored under delusions of persecution, believing he was being tormented and threatened by Peel’s Tory Party. A jury found M’Naughten insane and the Court was compelled to explain the verdict - the Queen was not happy.

Since 1723, the Common Law insanity standard had rested on the case of Edward Arnold, where the Court noted that “it is not any kind of frantic humour” that renders a person insane, “it must be a man that is totally deprived of his understanding, and doth not know what he is doing, no more than an infant or a Wild Beast. 
M’Naughten did not act like a “Wild Beast.” He was not deranged or delirious, and he was not consumed by manic agitation. He was a “madman” of a different sort.

Justice Tindall explained that a person must also be found insane if they were acting under the influence of a delusion “which if true” would serve to justify or excuse their behavior. In the context of their delusional system, the person does not know right from wrong, even if they are otherwise seemingly rational. 

Pelosi said that Trump was as good as insane after Trump told George Stephanopolous that it is still OK for him to accept foreign help in his election efforts. Trump said he would welcome assistance from Norway and claimed that the FBI Director was “wrong” about the propriety and legality of such collaboration. 

If Trump ever does plead insanity - claiming he believed that everything he did was OK - a forensic examiner will have to determine whether he was delusional or just character disordered. Did a psychotic thought disorder impair his capacity for moral reasoning or does he just happen to have his own set of moral standards that run contrary to those of society?

If Trump has clinically impaired reality testing (i.e., psychosis), he could be found insane. If his actions are simply a manifestation of dissocial and antisocial beliefs (i.e., sick ideas and character pathology), he would be found sane.

In California, the case law that guides an expert’s opinion regarding this distinction is the precedent set in People v. Stress (1988), where the Court articulated what can be referred to as the “Law of Subjective Moral Precepts.”

In November 1985, Stanley Stress killed his wife, leaving “an ax embedded deep in her head.” His belief was that “drastic action” was necessary to gain attention and publicly expose a vast government conspiracy. Extensive psychiatric observation confirmed that Stanley was “a paranoid and psychotic man whose life was taken over by his delusional beliefs.”  

Stress knew that killing his wife was a crime. The trial judge instructed the jury that he therefore must also have known that it was morally wrong. The Appellate Court disagreed, saying that even though he knew his act was illegal, Stress believed it did not violate “society's generally accepted standards of moral obligation.” Because he was delusional, Stress thought that people would agree that he did the right thing. 

The situation is different when a criminal, a narcissist or a sociopath claims that what they did was OK or justifiable, based on their "own distorted standards” or their “prison-influenced standards” of morality.

The insanity rule applies when a defendant with clinically impaired reasoning fails to understand society’s moral imperatives. The Stress Court said that insanity does not apply when the excuse is based instead on “the subjective moral precepts of the accused.” 

In clinical terms, those “subjective moral precepts” are the equivalent of antisocial attitudes, values and beliefs, the markers of character pathology and personality disorder. 

On one occasion, a defendant pleading insanity told me that he killed a fellow inmate at new Folsom Prison because the guy called him a punk. He said that “if someone calls you a punk and you don’t do something about it, then you are his punk … and the voices said I should do it. 

This killer was mentally disordered, but he was also antisocial. He believed that violence and aggression are acceptable methods for resolving various interpersonal difficulties in life. His beliefs were of precisely the same character as Donald Trump’s core belief about vengeance. 

In a speech, Trump expressed his dissocial conviction as follows:
“If somebody hits you, you’ve got to hit ’em back five times harder than they ever thought possible. You’ve got to get even. Get even. And the reason, the reason you do is … you have to do it, because if they do that to you, you have to leave a telltale sign that they just can’t take advantage of you.”
In other words, Trump’s moral creed is precisely aligned with that of a psychopathic killer who told me that you can’t just let someone get away with calling you a punk. 

And that is why Donald Trump will never be found insane. 

The experts might say that he has made some quasi-delusional statements (e.g., “I am the chosen one”), but they are likely to conclude that such utterances are a sign of malignant grandiosity and not evidence of actual delusions of grandeur. 

But the experts will also note that Donald Trump operates on the basis of his own distorted antisocial standards - his own subjective moral precepts. Depending on which crime triggers a prosecution, an expert might observe that Trump thinks there is nothing wrong with using a charity for his own benefit, bribing a porn star to influence an election, sexually assaulting women, obstructing justice or accepting emoluments. 

The question of psychosis versus psychopathy would also be triggered if Trump were ever to explain: “I knew I could get away with it, so I thought there was nothing wrong with shooting that guy on 5th Avenue.

Copyright, Paul G. Mattiuzzi, Ph.D.


Expert Opinion: Donald Trump Does Not Have a Mental Disorder

Never before in history have so many commentators prefaced their remarks about a President by saying: “you’d have to ask a psychiatrist” or “I’m not a psychologist.”

I am a psychologist. During the course of a 40 year career, I practiced as a criminal forensic specialist, visiting clients in jails, prisons and asylums, and testifying as an expert witness.

Having worked primarily in the context of active criminal proceedings, I look at diagnostic questions more critically than clinicians credentialed in academia.  

President "My Sick Idea" Trump 
The most prominent voice in the Diagnose-Donald-Now Movement - aside from George Conway, derisively known as Mr. Kellyanne Conway - is that of Bandy X. Lee, respectfully known as a Yale psychiatrist. In 2017, she published essays from 27 assorted mental health experts under the title: “The Dangerous Case of Donald Trump.” 

In Dr. Lee’s book, a number of the experts bandy about words that are associated with different forms of mental illness, but it remains a discussion about character, personality type, temperament, judgment and behavior. Mr. Trump was excoriated on those grounds, but no diagnostic hypothesis emerged. More importantly, no distinct and unequivocal symptom of mental disorder was described.


Is Donald Trump a moron? 27 experts fail to answer the baseline question.

Book review (originally published at Amazon):

It turns out that the 27 psychiatrists and other experts represented in this collection of essays did not produce any consensus opinion or “assessment” of Donald Trump’s mental health. Instead, they have shared individual perspectives, integrated primarily around the alarm, distress, disgust, angst, fear (and loathing) they all seem to feel in reaction to the President.

To the extent that a unified psychological profile emerges from these essays, the formulation is lacking any comment on the President’s intelligence - a foundational psychodiagnostic measurement. From a clinical perspective, nothing about his behavior should be interpreted without first answering the baseline question: is Donald Trump a moron?

The experts here are silent on the intelligence question.

Psychiatrist David M. Reiss identified “innate, baseline, intellectual/cognitive skills and ability” as one of five areas of concern regarding “the cognitive abilities of a POTUS.” He concluded, however, that no standards exist for measuring the I.Q. of a politician, and therefore, when it comes to this question, differentiating objective opinion “versus politically based propaganda is an insurmountable problem.”

A concern about an appearance of bias did not stop the other essayists from outlining the now-familiar contours of Trump’s personality type and temperament.


Expert opinion: Donald Trump does not have a personality disorder

Special to The Bee

Personality and character are always at issue in a presidential election, as is the sanity of the candidates. When a contender is referred to as a madman or lunatic, the comment is usually understood to be hyperbole.
No one has accused Donald Trump of hearing voices or howling at the moon. However, many have called him a narcissist.

I have qualified in court as an expert in the psychodiagnostic arts. In prisons and in jails, I commonly encounter narcissists, owing to the fact that clinical narcissism is a core component of the psychopathic mind and sociopathic character.
As an expert in diagnosing disturbances of mind, emotion and character, I can state confidently that Donald Trump does not have narcissistic personality disorder – a condition listed in the psychiatric Diagnostic and Statistical Manual.


The "Too Good Be True Test" is a Worthless Aphorism

When it comes to avoiding scams, schemes and other rip-offs, there is no more universal piece of advice than: "if it's too good to be true it probably isn't." This is usually said after someone has been victimized.

Most everyone is familiar with this pithy observation - an aphorism with a ring of truth to it - but it is familiar only because the warning so persistently fails to prevent people from jumping into the quicksand.

In hindsight, it is easy to see that relative to the cost and risk involved, the expected gain was unrealistic. In the rear view mirror, it is obvious that the promises were extravagant, false and empty.

To know whether something is true and to be trusted, we are told that all you have to do is measure how good it is.

The problem is that "goodness" is not a valid or reliable measure of truth. 


Do Psychopaths Genuinely Lack Empathy, Or Are They Feeling You?

The most common observation made about psychopaths is that they feel no empathy. I have said it myself in Courtroom testimony, repeating a truism I picked up years ago: "they fail to empathize and are therefore prone to victimize."


Psychopath or Sociopath? It Makes no Difference What you Call Them

Originally published at The Huffington Post.

From the earliest days in my career as a criminal forensic psychologist, I have encountered treatises and learned discussions about the difference between psychopaths and sociopaths. Still, to this day, I have never had reason to use the terms, other as than as synonyms.