Theresa Riggi: The Tragedy of Personality Disorder

The idea of this blog was intended to be an excuse to get away from the serious stuff of mental health writing and training and throw a few curve balls at some of the weird and hopefully amusing stuff that pops into my head rather too often than is healthy. But occasionally there will be more serious and sometimes darker corners that I’d like to explore, especially if it offers the reader a little lifeboat of clarity in the very choppy waters of psychiatry and the tidal waves of jargon, myth and sometimes utter shite that pours out of our web browsers and many other places besides.

I spent many years working with people who had done very, very bad things and had ended up in secure psychiatric units and prisons, but even I am still occasionally stopped in my tracks by a news story that almost defies belief. Today three men have been remanded in custody following the death of an elderly couple. They were stabbed and battered with a hammer. Perhaps you, like me, even tried to imagine yourself hitting an elderly person with a sharp, heavy lump of metal on the end of a handle. But thankfully most of us (self included) don’t get further than a fleeting micro-second on this thought before returning thankfully to irritation with the Royal Wedding or deciding whether to have Couscous or Maccy D for dinner. Most of us will often settle for the idea that such offences are the result of being drunk, high on drugs, desperate for money to buy drugs, or insanity. Nice simple responses to unimaginably evil stuff is a comforting way of keeping the bad people out and returning to our normal, uncomplicated lives.

But perhaps even further beyond our everyday comprehension is the idea of a woman stabbing her three children to death. Yesterday Theresa Riggi was sentenced to 16 years imprisonment after pleading guilty to the charge of culpable homicide on the grounds of diminished responsibility. It’s probably natural to feel even more astonished about this than the Wolverhampton killings allegedly committed by three homeless men. After all, Riggi is a woman and a mother. From the little we can glean from the news reports, she is a reasonably well-heeled, middle class woman who appears in the dock not in the tracky-bottoms and hoop earrings of our stereotype ‘bad girl’ but a smart, tailored white suit, flowing blond hair and immaculate make-up. The image of the woman who has stabbed her three children doesn’t just jar with our expectations but blows them out of the water with an almighty bang.

Putting our social stereotypes to one side for a moment, it may also seem very strange to most people that a person can be found guilty of a crime, given a prison sentence and yet their responsibility for the crime is in some way ‘diminished’. Well I’m no lawyer and can’t claim to try and explain the legal mechanics of the case, which under Scottish law operate a little differently than those in the rest of the UK. But as a mental health professional, writer and trainer I’ve spent many years explaining (some would rightly say ‘trying’ to explain) something called Personality Disorder, the diagnosis applied to Riggi and the reason why her crimes were ascribed to something other than either mental illness on the one hand, or ‘free will’ on the other. And this is my contribution to helping the confused reader feel a little less confused about what is a very poorly misunderstood area of mental health.

Theresa Riggi will have been examined by psychiatrists who provide a medical report to the court. Had the psychiatrists found evidence that she believed she was being controlled by God or receiving messages from an alien mothership, heard voices in her head telling her to kill her children and had been behaving erratically prior to the homicides they might well have concluded that there was evidence of a severe mental illness contributing to what she had done. After a great deal more investigation and more concrete evidence than the hypotheticals I’ve mentioned here, they might have recommended to the court that she receive treatment in a secure hospital or psychiatric unit as opposed to the determinate prison sentence she received.

But her behaviour was not explained by a ‘psychotic’ illness such as Schizophrenia, Bipolar Disorder or severe Depression (I’ll write about these at a later date, but Introducing Mental Health: A Practical Guide might help if you can’t wait) and nor was it described as the result of an otherwise ‘normal’ person with a ‘normal’ personality.

Okay, I’ve been running courses long enough to know exactly what you’re asking now: “What is a ‘normal’ personality?” Well for the moment I’d suggest typing that one into Google AFTER you’ve finished reading this AND had several Expressos because it’s a very mysterious question and way out of the scope of this article. Lets just say if you’re reasonably nice to children and animals, enjoy your life, get on well with others and don’t fantasise about doing weird stuff with power tools – you’re probably reasonably ‘normal’. Theresa Riggi was not considered normal and was diagnosed with three different forms of Personality Disorder.

So what exactly is this ‘Personality Disorder’ thing? Anyone who has ever read a tabloid newspaper or watched CSI has some idea of what a Psychopath is. They are bad people who do nasty things. The word ‘Psychopath’ is closely related to Personality Disorder and until 2007 formed part of our own UK Mental Health Act, but is no longer used by mental health professionals other than on those odd occasions when we need a shorthand way of saying ‘person with Personality Disorder’ and we think nobody else is listening. Not terribly PC and not academically correct but much quicker than reciting the full six syllables of Pers-on-ality Dis-or-der, so for the purpose of this article I’ll do what I normally do in training and ask for permission to use a jargon abbreviation: PD. Permission granted? Thank you.

In the same way that we use ‘Dementia’ as a convenient umbrella term for example, Alzheimers Disease or Vascular Dementia, PD is also an umbrella term for a number of different types of disorder which mental health professionals refer to these as ‘sub-categories’ of PD. I prefer to call these ‘flavours’ which include some of the better known diagnoses such as Borderline PD and Anti-Social PD as well as the lesser known Schizoid, Schizotypal, Dependent or Avoidant. 

But the overall meaning of PD refers to a person who is fundamentally unable to cope with life without annoying, upsetting or harming both other people and, invariably, themselves as well. They can be superficially ‘normal’ in many ways and can be gregarious, humorous, charming and even charismatic, especially when there is a ‘pay off’ for engaging others. But they are far less successful in maintaining relationships once the immediate payback has been realised, and tend to be extraordinarily self-absorbed as well as hostile and self-destructive. They live their lives in ways which are either highly methodical or completely chaotic, and have an ability to either attract or repulse others like the poles of a magnet depending the circumstances. 

While roughly one in ten of the population have personalities which meet the strict diagnostic criteria for one of the personality disorders, most of these individuals won’t have been labelled by a psychiatrist or psychologist until a researcher carrying a clipboard and wads full of questionnaires has interviewed them for a research study or court report. But before you start counting up just how many of your friends, family, work colleagues or acquaintances might make up the ‘1 in 10’, it’s important to qualify that people with PD are by default often (but by no means always – see below) marginalised at the fringes of society. Male and female prisons have extraordinarily high rates of people who have PD (whether or not it is recognised or written down anywhere) as do, for example, street homeless populations, drug treatment centres and just about any of the communities most of us with a family, a dog and a family saloon don’t really want to think about unless it’s a documentary on BBC4.

On the other hand, there are some people with PD tendencies (again, usually undiagnosed) who manage to achieve extraordinary success in business, politics and other more surprising areas of life. Think about some of the less than pleasant characters that have dominated entire nations and global corporates since the time of Caligula onwards and you get the idea. Some of PD’s less savoury diagnostic criteria can be a positive boon for world domination.

Some of the flavours described by the diagnostic ‘bibles’ used by doctors and psychologists (such as ICD-10 and DSM-IV) are perhaps of less clinical usefulness than others, and we would need a very long blog indeed to describe the whole collection in any detail, but let’s return to our original question: Why was Theresa Riggi not deemed fully responsible for killing her children and what role might PD have played in this awful tragedy?

The examining psychiatrists applied three separate diagnoses or flavours to Riggi’s personality: Narcissitic, Paranoid and Hysterical (sic). The ‘sic’ bit is down to the media reporting of a disorder I’ve never actually heard of but is almost certainly and more accurately called Histrionic Personality Disorder.
Let’s take a brief look at each of these diagnostic labels to try and make sense of what happened in this case, although I of course remind the reader that we are only dealing with the minimal information as reported in the press and I have no personal knowledge of the case.

Paranoid Personality Disorder
Paranoid or paranoia are words we all know quite well and perhaps even use with friends and family. Everyone has experienced paranoia at some time to one degree or another. You’re sitting in a pub with some friends and a loud peal of laughter erupts from a table of folks at the other end of the bar, and you think “shit, I know I shouldn’t have worn these tartan shorts and the dayglo green Crocs” while shifting uncomfortably and trying to see where the laughing folks are aiming their collective gaze. This is the very mild sort of paranoia we all experience from time to time, especially if we’ve had a few glasses of wine or don’t have very high self-esteem. Or most probably both.

But in it’s full-on clinical sense, paranoia is a very intense feeling of suspiciousness and unease that destroys a person’s ability to form friendships, socialise or even pop out to the local Tesco without the very real (to them) belief that everyone in the Sauces and Condiments section is plotting to poison them. Paranoia and the false beliefs generated by psychotic illnesses such as Schizophrenia occasionally (very occasionally) lead to violence and even homicide, particularly where a person becomes so consumed with their suspicions that they feel forced to extreme acts as a means of self-protection.

Paranoid PD is a strange beast in that it manifests as severe, all-encompassing and abnormal suspicion of others without leading to the complete destruction of reality we associate with a psychotic illness like Schizophrenia. Of course, it’s a hugely difficult task to draw clear lines in the sand between a) the paranoid beliefs of the sort that can be treated successfully with anti-psychotic drugs, b) the paranoia identified by Theresa Riggi’s psychiatrists as being part of a personality disorder, or c) the result of an unwise choice of footwear and a few drinks, but hopefully the picture might appear a little clearer now.

Narcissistic Personality Disorder
Narcissus is a character from Greek mythology. He was the son of a God and Goddess who, were he around today would no doubt be described by girls as ‘totally buff’. But Narcissus knew only too well about his buffness and rejected numerous come-ons from lots of water nymphs and other mythological characters because none of the boys, girls or hermaphrodites (this is Ancient Greece after all) who fancied him were deemed by Narcissus to be anywhere near good enough for the gorgeous young chap. Stay with me here, there is a point to all this.

To cut a long story short, Narcissus caught sight of himself in a pool and fell in love with his own reflection. Which wouldn’t have been too bad if he hadn’t become so obsessed with his reflected gorgeousness that he couldn’t move from the pool and eventually faded away and died of starvation.

A person diagnosed with Narcissistic Personality Disorder might be thought of as pathologically self-obsessed, vain and arrogant to the point that they really are very difficult people to warm to. They are, like their namesake Narcissus, so in love with themselves that they reject the attentions of others as being little more than an irrelevance, but may tolerate people who can a) achieve objectives for themselves such as the confirmation of their wonderfulness, or b) are of such high status that they are actually seen as almost being good enough to be in the same company, and c) may provide the narcissist with material resources and family associations to enhance and confirm their exalted sense of self worth.

This is often a person who, to anyone else but themselves, is actually a rather strange, unlikeable person who tells very tall tales to confirm their own inflated opinion of themselves – in fact, some of us sometimes refer to Narcissitic PD as ‘Walter Mitty Syndrome’, but please don’t quote that in any essays or course work you may be doing. 

I once worked with a colleague who would tell anyone that would listen (a rapidly diminishing number, surprise surprise) about his previous exploits of derring do as a member of the SAS. Now anyone who knew this chap would immediately know that this and his many other stories were patently ludicrous, but he not only told these obvious lies with great and even entertaining conviction but even seemed to totally believe them himself. Talking of conviction, the last time I saw him he was being arrested at work for a serious assault on his long-suffering partner of the time, and much to the relief of his colleagues was never seen again, much to the relief of his former colleagues.

Unfortunately and only in extreme circumstances, Narcisistic PD erupts in crime or extreme violence, usually as an attempt to perpetuate a lie or a self-belief. While we have no evidence as to how Theresa Riggi’s diagnosis contributed to the killing of her children, another example of the potential tragedy of this disorder is the Brian Blackwell case

Histrionic Personality Disorder
You’ve almost certainly used the term ‘Drama Queen’ to describe someone (usually and very innacurately a female) who craves attention and needs to be noticed. We probably only call someone a Drama Queen in jest or in certain situations, but if we take our everyday meaning of this expression and amplify it to suggest a person whose entire life and personality is dominated by their unswerving need to be the centre of attention then we are some way towards understanding the clinical meaning of Histrionic PD.

I always think of television shows such as Big Brother, X-Factor etc as a potentially fertile researching ground for any keen psychology researcher looking into this disorder, and it often seems to me that half the peak-time output of ITV2 is dedicated to Histrionic PD. Unfortunately the clinical picture of this flavour of PD is more likely to be associated with dramatic outbursts of destructive or self damaging behaviour than the invitation of cameras to watch a minor celebrity having a row with a partner or getting a bikini wax.

So what we can conclude from all this? A quote from the BBC News website  says a great deal about Theresa Riggi:
One of her friends, Amber Sebold, told BBC Scotland about the “wall of shock” she experienced when she heard about the killings.
“She (Riggi) always seemed very together. They were always immaculately dressed, very well cared for,” she said.
“She clearly loved them very much, that was never in question.”

Personality Disorder is, to repeat from earlier on in this post, a very complex and controversial subject. My personal opinion based on years of working with prisoners and psychiatric patients is that it is a very real disorder, but there are certainly many other psychiatric diagnoses that are seen as little more than doctors trying to medicalise anti-social, self-destructive or eccentric human behaviour. There is now an increasingly compelling body of evidence as to how genetic, biological and environmental factors combine to generate a ‘perfect storm’ in which a personality becomes capable of destroying the lives of both the self and others with such devastating effect.

Many of you will have read the accounts such as the one cited above and seen the photographs of a rather glamorous, expensively dressed woman posing for family portraits looking every bit the image of contented and successful family life. You have read this article and the accounts of what Riggi did to her children and are trying, probably in vain, to paste these images together.

As a keen science nerd I try unsuccessfully to get my head around the almost incomprehensible concepts of space-time, the universe(s) and the utter weirdness of quantum physics, but we are probably far nearer understanding the nuances of quarks, anti-quarks and black holes than we are to understanding the human mind, and stories such as these don’t just underline that point but squiggle underneath it with a great big smelly red marker pen.

This article has done little more than make a sub-molecular scratch on what is an enormous surface, but hopefully sheds a little light on how something as impossibly tragic as the death of three young children can be understood as well as condemned.

Visit JCK Training for details of in-house courses on Personality Disorder and our other health and social care subjects. 

Third Time Lucky

Q: So what went wrong with the first two attempts Connor?
A: Well, with a title like Connor Kinsella’s Mental Health Blog, it was a bit limited in scope. And a bit boring. And my mate defiled version two by calling me ‘dude’ and asking when we were next going to play tennis.
Q: So mates are banned from commenting and you have a wider brief this time around?
A: If I think of stuff that can be written down, is a) interesting b) amusing or c) just plain daft, it might end up on here. And I’ve written or co-written real books in the real world so hoppefully this will be more than just ego masturbation.
Q: Er, ego what?
A: Don’t worry. The spellchecker won’t pick it up anyway.