Michael Stone, M.D., a professor of clinical psychiatry at Columbia University, will freely admit that he has a "morbid hobby." He collects information about people who have committed atrocious deeds. Some of these are notorious killers who have had books written about them. Others are individuals whom Stone knows personally from his forensic work.

When Psychiatric News asked Stone what prompts him to collect material on people who have engaged in heinous acts, he said that he has become increasingly interested in such people over the years—in the dark side of human nature, so to speak. And a lot of them are sadists, Stone reported at in May at APA’s 2002 annual meeting in Philadelphia in sessions on sadism and evil.

What is sadism? While it is related to evil, it is not quite the same, Stone explained. Whereas evil is intentionally hurting another person, sadism is not only the intentional imposition of suffering on another person, but enjoyment in seeing that person suffer.

Take, for instance, the case of a man who shot his daughter while he was on the phone with his ex-wife, Stone said. The act was evil in relation to the girl because she died immediately, and the man could not derive any enjoyment from watching her suffer. But the act was sadistic in relation to the ex-wife because she suffered anguish upon hearing her daughter shot and the man could derive pleasure from her pain.

Ann Burgess, D.N., who is a professor of nursing at the University of Pennsylvania and has helped rape victims, recounted one of those rape cases. "There was a lot of blood everywhere. It looked as if the victim had been pounded against a car window." Yet the rapist shrugged his actions off with this comment: "It was rough sex."

Yet sadism can take much less flagrant forms, Burgess pointed out—say, in verbal cruelty in which one person puts another down. Joseph Merlino, M.D., a professor of clinical psychiatry at New York University School of Medicine, agreed with Burgess. When one hears about evil or sadism, he said, it "conjures up creepy organ music." But evil and sadism, he said, can be "present in petty cruelties in everyday life."

Why are people sadistic? The major reason, it appears, is the desire to control one’s victim, Stone and Welner reported. Stone cited a case that illustrates how the desire for control can drive sadism. A district attorney treated his mistress sadistically. When she tried to escape from him, he caught her, killed her, and packed her body in a trunk.

Revenge, however, can also prompt some people to commit sadism, Stone pointed out. He cited the case of a man in Japan who had a palm deformity and resented it to the point that he wanted to take revenge against society for his misfortune. So he killed children, chopped off their hands, and sent the hands to their parents.

What types of people engage in sadism? Serial killers and psychopaths, for starters, Stone reported. Of the some 100 serial killers he has studied, he said, more than 90 percent were psychopaths. And psychopaths in turn, he explained, are extremely narcissistic, impulsive, sensation seeking, and deceitful. They also lack goals, compassion, and remorse, and sponge off others. In Stone’s opinion, the most depraved people who commit homicide are psychopathic murderers who enjoy torturing their victims.

Nonetheless, it is not just serial killers and psychopaths who engage in sadism, stressed Michael Welner, M.D., a forensic psychiatrist and chair of the Forensic Panel in New York City. People who function otherwise "normally" in society can be sadistic as well.

The people who engage in sadism, Stone indicated, may include that tyrannical, mildly abusing husband down the street or the bully in one’s class. And while sadism is practiced more by men than by women, Stone said, Welner added this caveat: "If we think it is only men who are sadists, we are kidding ourselves."

People who commit crimes of passion, however, are rarely those who engage in sadism, Stone pointed out, and far more sadists can be found in prisons than in forensic psychiatry facilities. In short, sadists tend to be "bad, not mad," he said.

If sadism is one of the murkiest, most reprehensible of human behaviors, is there any chance of successful treatment? Sadistic persons rarely seek treatment and are generally untreatable, Stone said. However, "some do have the capacity for remorse and self-reflection," he acknowledged. For instance, he worked with one woman on becoming less brutal with her son, and after several years she managed to do so. Of course, she was not nearly as depraved as many sadistic people are, he admitted.

Welner proposed that antagonists against the neurotransmitter dopamine might help to counter sadistic behavior. Dopamine has been associated with mediating feelings of pleasure and reward. Blocking dopamine could curb sadistic behavior because sadism, he said, "is about satisfying compulsions."

And if sadism is one of the most loathsome of human behaviors, is there any chance of preventing it? Possibly, Welner indicated. For instance, he said, one of the best ways to identify youth at risk for sadism is by zeroing in on young people who torture animals. "I think that animal torture is a practicing instrument for later sadism against people, and such behavior in youths should be a big alarm bell," he said. Psychiatrists and mental health professionals might then try to awaken empathy in these young people, he added—say, by focusing on when they had been mistreated.

"Working with adolescents will certainly prove more beneficial than working with adult offenders who have already tasted blood, so to speak," Stone said.

Empathy training in schools might also help counter sadistic behaviors, Welner suggested. And placing more control over pornography might also make a dent in sadistic behaviors, he added, since pornography has been shown to be closely linked to sadism.

Since prostitutes are often victims of sadism, Welner suggested that the number of injuries caused by sadistic individuals could be reduced if the police were to engage in better communication and undertake educational efforts with prostitutes.

All in all, Stone concluded, sadistic behaviors are far from rare in American society. "So why should we psychiatrists turn a blind eye to the sadistic personality?" he asked. "I think we should put it back in the DSM."

It was provisionally in the appendix of DSM-III-R, he explained, but was subsequently omitted, in part because psychiatrists worried that its inclusion, its "medicalization," might be used by defense attorneys to get sadists exonerated from their criminal acts. Of course, if it is included in the DSM, he asserted, it should not be used for that purpose. ▪