Dr Dorothy Otnow Lewis, a clinical psychiatrist now in her 80s, has spent over 30 years interviewing more than a hundred murderers, death row inmates, and some of America's most notorious serial killers, including Ted Bundy and Arthur Shawcross. Her work is the focus of Alex Gibney's documentary Crazy, Not Insane, which explores her career and the controversial conclusions she has drawn about the roots of extreme violence.
Lewis has consistently testified for the defence in death penalty hearings, arguing that many killers are not inherently evil but are shaped by a combination of environmental and biological factors. 'These people were not born dangerous. They were not born evil,' she told the Guardian. 'You get a combination of factors, environmental and intrinsic, that create a very violent person.' She emphasises that 'evil' is a religious concept, not a medical one.
Alongside neurologist Dr Jonathan Pincus, Lewis identified three common factors in violent offenders: predisposition to mental illness (especially psychosis), abnormal brain dysfunction (particularly in the temporal or frontal lobes), and a history of horrific childhood abuse, often linked to dissociative identity disorder (DID). Her use of DID as an insanity defence in the 1980s, notably in the trial of Arthur Shawcross, was initially dismissed but the condition is now recognised in the DSM.
Lewis's methods have faced criticism, with some psychiatrists suggesting she coaxed impressions of separate personalities from interviewees. She counters that evidence of segmented identities often appears in old records, such as letters, diaries, and artwork, which can show markedly different handwriting and vocabulary between personas. She also uncovers evidence of abuse through bodily scars, family interviews, and parental medical records.
The documentary traces Lewis's philosophical evolution from a Jewish child in 1940s New York, fixated on what made the Nazis tick, to a career dedicated to understanding the darkest capacities of the human psyche. 'I don't think anyone is born evil,' she says. 'Or else, maybe you'd say we all are born with a capacity for evil, and you handle it differently.'
