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In Focus: In ‘Crazy, Not Insane,’ on HBO, entering the minds of serial killers

Forensic psychiatrist Dorothy Otnow Lewis with sketchpad, in "Crazy, Not Insane."
Forensic psychiatrist Dorothy Otnow Lewis with sketchpad, in "Crazy, Not Insane."HBO

In this year alone the prolific Alex Gibney has taken on COVID-19, in “Totally Under Control”; Russian interference in the 2016 presidential election, in “Agents of Chaos”; and wrongful conviction by the justice system in “The Innocence Project,” Now he turns his attention to the psychopathology of serial killers in his engrossing, provocative “Crazy, Not Insane.”

One of the most disturbing is not Ted Bundy but Sam Jones who, when asked how many people he has killed, says, “I don’t know the exact number, 18 or 19, I lose count.” Interviewed by the film’s subject Dr. Dorothy Otnow Lewis, a psychiatrist who has for decades been investigating why people kill, he tells her that he “don’t feel a damn thing about it. … I sleep good at night.”


Jones sleeps not on death row but in a trailer in Louisiana. He is an itinerant executioner, paid by the state to kill. Lewis wonders if she has at last found a true sociopath, someone devoid of empathy, without a conscience, and with no personal history of abuse, trauma, or brain injury to account for it. But as she continues to question him, he lets drop the fact that he was beaten by his parents and had several times been the victim of violence assault and served time for assault and battery.

Then he tells her that after each execution he paints a canvas with acrylics. He shows some of the paintings to her: They are nightmarish, exploding with violent colors, featuring tormented faces like that in Edvard Munch’s “The Scream.” They are as scary as a John Wayne Gacy clown painting.

Dorothy Otnow Lewis in "Crazy, Not Insane."
Dorothy Otnow Lewis in "Crazy, Not Insane."HBO

“I have seen 22 serial killers and a lot of plain old killers,” says Lewis. In almost every case, she contends, these criminals acted not because they were essentially evil but because they themselves were victims of criminal violence, often as children at the hands of their parents or others.


Lewis never planned to make a career of interacting one-on-one with some of the country’s most heinous criminals. Though she was fascinated by the Nuremberg trials as a child and wondered whether anyone, even herself, was capable of becoming a Nazi and a killer, she entered the medical profession with the intention of a career in psychoanalysis, listening to neurotic patients talk about their dreams and complexes. But in the early ’70s she was working in the clinic for the juvenile court in New Haven and discovered that many of the violent delinquents had been the victims of horrendous abuse. She pursued this insight and determined that not only did this affect them psychologically, but physiologically also, something that MRIs revealing abnormalities in their brains would confirm.

After further research Lewis discovered that some serial killers, perpetrators of the most abhorrent crimes, suffered from dissociative identity disorder (once known as multiple-personality disorder), a controversial diagnosis. To defend themselves against the pain and degradation of past experience, Lewis contends, victims unconsciously create new personae, complete with names and characteristics that embody their rage and helplessness. They are possessed by these entities when they commit their gruesome crimes.

Her work attracted defense lawyers, especially those with clients facing the death penalty, who sought her testimony establishing mitigating circumstances. In one case Lewis testified on behalf of a defendant during an appeal of his death penalty sentence; and while on the witness stand, she noticed that the man was in the midst of switching personalities. Lewis pointed this out to the judge, and he was so impressed he reduced the sentence to life imprisonment.


Dr. Dorothy Otnow Lewis testifies during the murder trial of accused serial killer Arthur Shawcross, 1990. From "Crazy, Not Insane."
Dr. Dorothy Otnow Lewis testifies during the murder trial of accused serial killer Arthur Shawcross, 1990. From "Crazy, Not Insane."Kevin Higley/Democrat and Chronicle-USA TODAY NETWORK via Imagn Content Services, LLC

But in a 1990 case reminiscent of Alfred Hitchcock’s “Psycho” (1960), Lewis endured embarrassing failure. Arthur Shawcross had been charged with 10 counts of murder, in one of which he cut out and ate the victim’s vagina. Lewis testified for the defense, which argued that Shawcross was not guilty by reason of insanity. She showed a video of her interview with Shawcross as he switched into the personality of his abusive mother, speaking in her voice as “she” claimed responsibility for the crimes.

The defense failed to back her up with crucial neurological evidence, and the politically ambitious district attorney made a point of mocking her on the stand. The jury found Shawcross guilty after less than two hours of deliberation.

Testifying for the prosecution in that case was Park Dietz, a famed forensic psychiatrist who is one of the old guard in the profession who dismiss Lewis’s decades of groundbreaking research. “It’s a hoax,” he says when asked by Gibney about dissociative-identity disorder. He points out that her use of hypnosis manipulated her subjects. Lewis, however, maintains that she uses that procedure sparingly and always with corroborating evidence.

“She was a pioneer, and pioneers are often not treated well,” insists Richard Burr, a defense attorney who was one of the first to enlist Lewis as an expert witness in a death penalty case. “What she had to say bore heavily on the truth, and the truth was not necessarily what prosecutors want to hear.”


“Crazy, Not Insane” can be seen on HBO beginning Nov. 18.

Go to www.hbo.com/documentaries/crazy-not-insane.

Peter Keough can be reached at petervkeough@gmail.com.