Sometimes I am very reluctant to weigh in on recent prominent national stories. At times I prefer to let the dust settle from the controversy of such issues, and also to permit my own reflective and responsive observations a chance to percolate through my mind and catalog of past experiences that I often like to bring to bear on very contentious, and especially emotionally upsetting national stories. This very sad saga, and recent suicide just a few days ago of the extremely controversial, to say the least, story of the convicted sexual trafficker and apparent pedophile, wealthy mysterious financier Jeffrey Epstein formerly of Florida is no exception. It has many attributes that could furnish an opening to the ever-present temptation to be very sensationalistic regarding numerous features of his life story. Most of us have had a very negative view of his sexual predatory misadventures of years ago when he was convicted, and as well, of the apparent exceptional and questionable treatment he was afforded in his prosecution and sentencing several years ago. I daresay few people registered any quiet self-contained objection to his being arrested again weeks ago for crimes committed in the New York jurisdiction.

But nonetheless, his death by suicide a few days ago is sad by any measure. But it brings up many issues. I have no desire to contribute to the already inflammatory usual stupid Internet-based extreme reactions such as conspiracy theories as to why his death came at this point in time etc. One of the stories is of course the expectable moral umbrage and outrage from a governmental and bureaucratic perspective voiced through the person of Atty. Gen. Barr. There is some understandable justification for this institutional reaction and inevitable review. For instance, it may be hard for many to comprehend how in the world this man could’ve suicided in such a secure facility with the capability for extreme observation and safeguards against such an occurrence of a person hanging themselves. There has been much discussion of why Mr. Epstein was not placed on 24 our suicide watch etc. And this is also understandable since very apparently, this gentleman made an alleged suicide attempt on July 23, 2019.

I have made it a point to listen to many of the news television outlets’ analyses and have not heard really only a very few analysts voice what I thought were well-placed thoughts. One clinical mental health person gave a very good explanation of the usual process that clinicians in such settings employ to ascertain whether a person is still potentially at risk to harm themselves, i.e. suicidal. This analyst made the telling points that individuals still if they are very sophisticated and capable of very polished dissimulation can mislead and in effect, deceive even the most competent mental health examiner. This analyst gave a very reasonable scenario that anyone could’ve employed to emerge from the close clinical precautions that intensive mental health facilities whether jails or inpatient psychiatric hospital units, employ to monitor for the possibility of and to prevent suicidal behaviors. But this analyst’s efforts were by far the exception. Many of the accounts either outrightly stated or hinted at, clinical and institutional malfeasance that they cited without information or evidence to back up their somewhat irresponsible or cavalier attributions of guilt and fault.

I do not wish to venture into the briar patch of cavalierly diagnosing Mr. Epstein either in order to flim-flam the reader into believing some faulty analysis I might employ. And I can easily resort to throwing around sophisticated-sounding and perhaps seemingly plausible diagnoses as a clinical psychiatrist.

I do wish to approach this very sad and tragic occurrence from a very different perspective. I don’t think for instance, that it is necessary to invoke a “fifty-dollar” diagnostic term to open a discussion of why I think what happened was possible. Instead, I think I can contribute a wee bit of earnest analysis and explication by simply focusing on this gentleman’s past history and behaviors.

More importantly, even to me as a psychiatrist, I find it completely irrelevant whether he is a certain clinical or personality diagnosis. It is simply not needed in order to generate a bit of understanding why this happened. Again, the basis for my approach in looking at this is sufficiently supported by looking at his characteristic behaviors.

First off, he apparently was an immensely wealthy individual. Being wealthy does not necessarily make one an evil individual. But the way this man utilized his wealth and immense resources in dishonest, predatory and heinous ways are explanatory. He apparently had utilized his wealth to buy his way into whatever social arena he wished to enter. And he apparently used his entry into those private walled-off worlds because he knew he could operate in the shadows and carry out his reprehensible behaviors. These of course allegedly included recruiting vulnerable underage adolescent girls for abusive sexual purposes.

Second, he utilized his wealthy resources to pay off accusers and victims to protect himself from exposure and prosecution for many years. This is a further extension of his “evil” (and I do not think this is too strong or inappropriate a descriptor to apply to his behaviors) modus operandi. The use of the word evil gets this entire discussion out of the trap of misusing speculative pseudo-clinical diagnostic exercises that are not only empty but misleading, and into a more appropriately morally based discussion. Nowadays to be politically correct, sometimes we are not supposed to use the word “moral,” at all. But I think it is appropriate here because of the gravity and the nature of his apparent offenses.

In other words, this man was wealthy enough to not only afford but most importantly, regrettably protect himself from the consequences and discovery of his offenses. He was able to apparently very much lessen the consequences of even his prosecution and penalties several years ago in Florida. There has been much discussion of what has been called a “sweetheart deal” and I won’t add to that presently.

What I do wish to do is to discuss this again as I have been implied above, from a very different perspective. I think that anyone who permits themselves to become ensnared by the universal temptations to our baser impulses that all of us have, and who are wealthy enough, to permit ourselves to be corrupted by the kinds of power that extreme wealth confers, can evolve into the kind of person that apparently this gentleman became. This is a viewpoint that originates from my mental health background and my own view of human nature. Some quarters of intellectual and moral thinking recoil at this postulate that any of us is capable of evil if we succumb to these universal temptations; but I have long thought that this is the case and is the reason for laws, moral precepts, religious beliefs and admonitions, and all the societal safeguards that every culture has.

There is a body of literature in psychiatry and in specifically in psychoanalytic theory and practice of several decades ago that originated from a group of psychiatric and psychoanalytic writers. That group of influential practitioners talked about these kinds of people in very telling detail. I do not wish to name this “school” of psychoanalytic and psychiatric thought, nor one of its primary proponents as it would tend to lead us down the rabbit hole of viewing this kind of personality aberration in the all too restrictive pigeonhole of a certain set of diagnostic concepts. But this school of thought is quite accurate and has a few concepts that I think are worth conveying.

One of the issues is that these kinds of people who have wealth, power, great influence and deficiencies in their personal ways of behaving and codes of ethics, function very much alike and very predictably. They are used to getting their way and can use their wealth to see that this happens. This is an old story and not a new concept to be sure. It is repeated over and over again in the hallways of power whether in corporations, government circles, military endeavors, etc.

Attendant to living in this rarefied world of extreme personal power that can be exercised often with almost total impunity, enjoying the lack of checks and balances by others, is that these folks view themselves as not only all-powerful but also not subject to the moral precepts built into the fabric of the governance of our social contract.

Consequently given this kind of sense of true invulnerability, these individuals live their lives certain that they can never be brought to justice, never be subject to effective criticism or correction and live a life that is totally foreign to the rest of us.

But when they come up against a final reckoning, a set of corrective circumstances that their money and power cannot protect them from, they fall very far, very fast and surprise us all. They suddenly are revealed as being as weak and vulnerable as anyone else. Their fall from power as it is often termed surprises many observers but in my view really should not be surprising at all.

This very special kind of person can react self destructively and suicidally in very short periods of time with little or no indication that they are crumbling within. And they can and often, will self-destruct almost immediately when their powerful self-protection is breached.

And this is what I feel happened to this gentleman. He functioned well in his own misguided way as long as his defenses, coping mechanisms as we mental health types would call them, were intact and effectively deployed. But when they no longer protect such an individual, the structure implodes from within and these folks suddenly become nonfunctional. The contrast between their previously powerful status and their dissolution is truly surprising to those who have not seen this before.

Those of us who treat individuals like this know this is a constant risk. And unfortunately it takes a wealth of experience and supremely skeptical clinical objectivism to remain ever mindful that their surface presentation with all their charm and urbane manipulative confidence is straining to the utmost to deceive a mental health examiner and to maintain the long term facade of power. And even the most skilled mental health clinician still can be deceived by them since we never can know fully and exactly what the person across from us in a clinical evaluation interview is truly thinking and intending.

Mr. Epstein saga I think is an example of this kind of clinical situation that is exceptional, but nonetheless still frighteningly instructive. No one should bring to bear too much self-righteous and indignant, ill-informed, criticism of how this played out recently unless there truly was careless clinical practice. We need to keep level and clear heads and at best, strive to learn from this very public and sad example of how a tragedy can sneak through the best of safeguards in the most secure of settings despite the committed earnest efforts of many kinds of professionals who are tasked with the thankless job of navigating these shoals of complexity on a day-to-day basis.