Book Review of The Psychology of Dexter: Part 3/3

This is my last post on The Psychology of Dexter and some of the posts that I found interesting. You can find Part I and Part II here.

There are two more essays I'd like to highlight. The first being The Psychology of Dexter's Kills by Marisa Mauro, PsyD.

I don't know about you but I get confused on the difference between the killer's MO and his signature and this essay provided good definitions that I thought I'd share here.

The modus operandi, often referred to as MO, are specific actions taken by the perpetrator in order to complete a crime. To be considered part of an MO, an action must be necessary and not superfluous, to carrying out the crime. As the MO is a set of learned behaviors that are used because they work. 

The signature, sometimes referred to as a "calling card" is another element of criminal behavior that occurs during the commission of a crime and entails all the aspects of criminal behavior that go beyond those necessary for the completion of a rime. A signature is most likely to be used by serial offender. 

Some examples given for signature were:

• Abusive, vulgar language.
• Excessive use of force.
• Scripted conversations.
• Actions to produce psychological trauma such as domination or humiliation.

The last essay entitled Deception by Bella DePaulo, PhD talked about how good loved ones are at perceiving deception. Sadly, not very good at all.

When put to the test, romantic partners in particular are not very good an knowing when their loved ones are lying and when they are telling the truth. The problem is they want to believe that their partners would never lie-- especially to them.

Even though sweethearts were hardly better than chance when they were asked directly whether their partners were lying, they did seem to know on some level, that something was not quite right. The strangers did not show as much sensitivity to the more subtle signs that something was amiss.

So-- I guess good news and bad news there.

Do you watch the show Dexter? If so, what mental health issues fascinate you about the series?

Book Review of The Psychology of Dexter: Part 2/3

I'm continuing my series on the non-fiction book The Psychology of Dexter which includes several essays examining some of the mental health aspects of the show. You can find Part I here.

The next essay I found interesting was Naughty by Nature, Dexter by Design by Joshua L. Gowin. This piece took a look at whether psychopaths are genetically that way or become that way through their environment. What I found intriguing was his discussion of a callous personality type and what it meant for children. Again, what follows comes directly from the text.

1. "Inheriting a callous-unemotional disposition is a significant risk factor in developing antisocial behavior and psychopathy. In most circumstances, antisocial behavior is equally the product of nature and nurture, but inheriting a callous disposition shifts the balance in favor of nature. Antisocial behavior in callous children reflects a genetic influence of roughly 80%." Some ways to identify that your child may have this callous personality type is that they don't soothe another child when they are crying or are insensitive to another child's pain. They do not regret mischief.

2. "The most effective treatment was to provide positive reinforcement for pro-social behavior. Because these children tend to be fearless, punishment does not deter them, but they are as sensitive to reward as other children." I found the discussion about fearless children in this essay pretty fascinating as well.

What do you think? Are psychopaths created by nature or nurture?

For more information on callous personalities check out the following links:

1. http://en.wikipedia.org/wiki/Callous_and_unemotional_traits

2. http://www.ncbi.nlm.nih.gov/pubmed/18489213

3. http://www.sciencedirect.com/science/article/pii/S0191886912003431

4. http://www.mental-health-today.com/articles/pd.htm

Book Review of The Psychology of Dexter: Part 1/3

Frequent followers of this blog know I'm a fan of the television show Dexter-- not necessarily for its medical accuracy but for its amazing plot and character development. Honestly, I wish I would have been the author to create a series about a vigilante serial murderer working for the police department.

Sheer genius. You can read some of my medical analysis of Dexter here and here.

So, of course, I was intrigued when I found the non-fiction book The Psychology of Dexter that includes a collection of essays on various topics analyzing the show from different mental aspects and, over the next few posts, I'm going to highlight some interesting tidbits I learned along the way.

The first essay I found interesting was titled Rethinking Dexter by Lisa Firestone, PhD. What follows are quotes from the actual book or are very close paraphrases. This particular essay dealt with childhood PTSD and  whether or not early treatment of psychopathic children could reduce their violent nature in the future.

1. "Research shows that a child's cruelty toward animals almost always arises out of an abusive family environment. Humane education that focuses on developing empathy toward animals generalizes to empathy for human beings. The National District Attorney Association suggests that targeted therapy at this could save future lives."

2. "Research suggests that psychopaths almost always are treatable if they receive intensive therapy for a proper duration of time." which throws out the theory that there is not hope for these types of people.

3. "Studies have shown that almost 100% of children who witness parental homicide develop PTSD because of the severity of the traumatic event. Eighty percent of children that have been imprisoned, rendered immobile in some way (buried alive, tied up, or tortured) will develop PTSD as well."

4. "Childhood trauma has an impact on actual brain development. It can cause serious structural abnormalities in the frontal lobe, known as 'the seat of emotion.' Brain researchers have found that these abnormalities often result in deep-seated personality deficits such as an inability to be empathetic."

4. "When childhood events are traumatic enough to cause PTSD, children dissociate from themselves as the helpless victim and identify instead with the aggressor. They identify with the very person who is hurting them, who they see as strong and not vulnerable to the type of pain they are experiencing. This is the only survival strategy available to the child."

5. "An additional common symptom of early childhood PTSD is post-traumatic play, in which children repeat themes or aspects of the trauma they experienced. This does not relieve anxiety."

Are you surprised by any of this information as it relates to childhood PTSD?

Top Three Medically Inaccurate Shows: IMHO

Let me say first, television shows are not a good resource for medical research. Scratch that-- reality shows where they actually film a medical team in action are good for sights, sounds, etc.

However, those fictionalized series written by writers are likely not. Here are my top three offenders as far as medical inaccuracy goes. This is not to say that I don't love watching these shows-- how else would I know they were so horrible for medical inaccuracy?

#3  Dexter: The reason I include Dexter on this list is that it perpetuated one of the leading medical myths. . . that you must keep the head injured patient awake. This is not true and doesn't prevent a serious medical outcome. You can read here about this medical myth.

 

#2  FlashPoint: From giving a patient (my favorite character) too much Morphine that would have likely killed him to my favorite sentence, "I can't detect a heartbeat. His blood pressure is low." For one, if you are listening to the patient's chest and can't hear a heartbeat, then your patient is dead and therefore has no blood pressure and should receive CPR post haste!

#1  Grey's Anatomy: I'm not even a surgeon and I know that watching Grey's likely causes surgeons across the country to go into lethal arrhythmias. Two of my favorite instances of medical inaccuracy. One was a patient who needed major neck surgery-- twice. After the first neck surgery, he's placed in a C-collar to prevent movement. But then, it becomes medically necessary to do plastic surgery on his ear (not life saving by any means). In that shot, the patient's head was turned all the way to the side so they could reach it. Guess his neck was stable after a mere few hours. Then he goes back for a second neck surgery and after that, isn't even in a C-collar. That is some rapid healing-- let me say.

My next favorite Grey's inaccuracy was the chief resident having control over the nurses' schedule. People, let me tell, physicians do not have anything to do with staffing nurses. Never. Especially to put them closer to a physician they are pining over.

What medical shows would you add to my list?

Medical Myth: Head Injured Patients Need to Stay Awake

I love the series Dexter. If you're unfamiliar with it and you're a writer, I think it's a great exercise in intricate plotting techniques. However, it is violent, so proceed with caution. The general premise is that Dexter works for Miami Police as a blood splatter specialist. In his free time, he's a serial killer, but only kills those that the justice system doesn't put away. This show is also good study for the sympathetic villain.

In one episode, poor Dexter has been in a motor vehicle collision. He is dazed and is taken to the ER. The doctor says something to the effect of, "You have a head injury. You'll need to stay awake for the next several hours." Great.

Sleepiness post head injury is a classic set-up for pediatrics. Every day in the ER is a story like this. It's close to bed time. The children are running amok. Some child falls down, falls into, or falls off of something and hits their head. They cry their little heart out. After all, hitting your head hurts, a lot. After a good crying bout, they're sleepy. Parents first thought is, he must have a terrible head injury. Off to the ER.

Now, one, I want to make it clear. Getting your child checked in the ER for head injury is good and reasonable. However, we aren't all that concerned with sleepiness. What we are concerned with is how arousable they are from sleep. This is what we'll be monitoring every fifteen minutes to an hour if the child sleeps during his ED visit.

Level of consciousness is assessed as an indicator of an injury going on inside of the head. How arousable you are is the most sensitive indicator of level of consciousness. If the child falls asleep, and we are concerned about head injury, we'll try to wake them up every so often to assess their level of arousability. If we cannot wake them up, then we are concerned. It has to be more than a gentle nudge. You are really working to wake the patient and they won't respond. This is concerning.

Remember, things that are injured need rest. This is why we put you on crutches if you break an ankle. The brain rests by sleeping. It helps it to heal. If you're a subscriber to this myth, how long should we keep the patient awake? An hour? Two hours? A day? If you want a skewed neuro exam, try doing one on a sleep deprived patient.

For additional resources regarding this myth, check out the following:

1. http://firstaid.about.com/od/headneckinjuries/f/09_Waking_Heads.htm

2. http://familydoctor.org/online/famdocen/home/common/brain/head/084.html

Did you believe this myth?