1 A Case Study of Ted Bundy Psychology 313 Courtney M. Guinn Due Date: June 22, 2013 2 A Case Study of Ted Bundy Clinician: Courtney M. Guinn Patient: Theodore Robert Cowell ("Ted Bundy") Date: January 23, 1989 Reason for referral: Ted Bundy is accused of killing 30 women across the Pacific West Coast. He was referred to by the defense attorneys and judge of his trial to determine what mental disorders he might be suffering from, the causes of those disorders and a possible treatment for those disorders. He admits to having bad mood swings, but does not refer to his down times as a depression. He understands that what he did was wrong, and has been trying to give a reasonable background but lack of evidence to claim himself innocent and not responsible. Knowing there is a possible history of mental illness in his family and the brutality of his crimes, an analysis of his mental status is required. He says that after he escaped from jail twice and during other events, he felt as if he was on top of the world, but that those feelings would subside and he would return to his average affect again. He describes these patterns as "simple changes". His psychotic kidnapping, raping, murdering and assault before killing his victims holds room for the possibility of biological, psychological, and/or social factors Relevant history: Patient's name is Theodore Robert Cowell, also known as "Ted Bundy". He is a 34 year old male and was born in a home for unwed mothers in Vermont. As a child, he states that he admired his grandfather when in fact his grandfather was abusive and inhumane, as was later revealed. Previous evaluations of Bundy exposed that his grandfather frequently was seen conversing with people who were not there and that his grandmother received ECT for depression. Both of these findings point to a history of possible mental disorders that run in the family. Others have suggested to him that his biological father could potentially be his grandfather; Regardless, he does not know who his biological father is and claims that as a child he never wondered about him or cared about who he was. In the beginning, while he was living with his grandparents, they claimed him to be their son to avoid social scrutiny of his real mother having a baby out of wedlock. He found out the truth after he found his certified birth certificate later in life and claims that he will forever have extreme animosity towards his mother for not telling him the truth as he grew up. Nevertheless, Bundy claims to have had two dedicated and loving parents who gave him a warm and comforting household. Still at a young age, his mother moved from Philadelphia to Washington and this is where he met the figure that would become his father, bring him four siblings and give him the famous surname "Bundy". He attributed his fast-thinking and academic excellence to his mother, but also holds the belief that something happened to her in her life that prevented her from opening up to him and talking about any personal matters. His stepfather was considered the head of the household but was, according to Bundy, not smart like his mother and couldn't really support them. His parents met 3 at a church social and enrolled Bundy in Bible study throughout his life up until the end of his high school career. He claims to remember, if anything, a very small amount of what he was taught. His parents weren't very political, which was important to him when he brought up how political he was. He grew up listening to the radio and explained that he did this a lot not because he was interested in what they were saying, but just because they were talking in general. He was very antisocial as a child. In high school, he tried to get into sports, but failed. He began to think that there was something wrong with him and he agonized over wanting to be better. He felt as though he did not socialize the way he should have and that he missed out on vital developmental stages of his adolescence. He acknowledged that in the classroom, he always spoke up and expressed his intelligence because the way you are perceived in the classroom was vastly different than the way you are perceived when in cliques of students in the hallway of his school. He would make up excuses about why he wouldn’t try and conform with his surroundings and never thought about going to a counselor because he never knew what was wrong, even though he knew that he was different. He felt menial because his parents couldn't afford most things and parts of life that he secretly wanted to be a part of. His only social activity was skiing and even then, he would steal equipment and forge his way to the top. His career against the law began at a young age. Later in life, during his senior year in high school, Bundy joined the political scene in a variety of different aspects and began to socialize in fields of social status that he believed he would have never been able to otherwise. He was enticed by the mysterious and promiscuous atmosphere. He went to two different colleges in Washington before dropping out after three years of attendance. He got into a relationship that lasted only about a year. She left him because of his lack of maturity and sense of direction regarding his career and life in general. He became very spiteful towards her. He went to another college in Colorado after she left him over these issues. He got a second girlfriend, a former divorcee, soon after and stayed with her up until he was put in jail. He got a job at the suicide hotline and reenrolled in his previous college in Washington. He got back into the political scene after he graduated and got into law school. He got back together with his first girlfriend and was dating both girls at once. He discussed marriage with the first girlfriend, but then ended it suddenly stating that he just wanted to show that he was capable of having someone to marry. He dropped out of law school and that was when his first killings supposedly began. Clinical Interview: During the clinical interview, a series of specific questions will be asked to get important background information and to allow the patients to answer questions regarding their symptoms with a brief answer. This interview will help me to interpret and observe Bundy’s life history and how he feels about it. To begin, I asked Bundy the date, his age and his date of birth to confirm that he knows basic environmental facts and is not delirious about his current situation. After asking about his marital status, he described his wife as loyal and devoted to him. His current support network is his wife and all of his "followers" that believe he is innocent. He has one child, a daughter who is 7 years old. He claimed that his childhood was not the cause of his killings, that he was content with his adolescent past. He used to be able to hold jobs, but ever 4 since he has been on the run, it has been impossible for him to settle down like that. His job for the past several years has been trying to determine who his victims should be. He felt pressure to choose the right person. He had no time to relax, he had to choose the right person and figure out how he was going to execute his plan. He doesn't really have any leisure activities, but he says that he counts all of the police and people that are accusing him of these crimes as his "friends", even though he shouldn't. He feels as if time with them is entertaining. He was arrested at least two times when it came to the robberies and possible car theft he committed while at the ski resorts. As for his substance abuse history, he admitted to drinking large amounts of alcohol and searching neighborhoods where he could find women and girls taking off their clothes in the comfort of their own homes. He has been labeled as an alcoholic and a drug addict. He professed to smoking marijuana and being an avid smoker of it as well. The only other drugs that he admitted to trying were prescription drugs like Valium. These drugs are not available to him anymore as he is incarcerated. He would smoke marijuana to calm himself during times of distress and when he was experiencing his low moments. It is noted that alcohol was used during some of his attacks. He explains that he doesn't really experience any type of severe depression or anxiety being in jail. When he was in the outside world, he was not able to control those around him and he was unaware of what was going to happen next. In jail, he is able to control, befriend or scare people. He exclaims that he has become in contact with the most dangerous people on Death Row and get along with them. The only way he would have any trouble with them is if he tried to have sex with one of them. He has never had any thoughts about killing himself; but, as it is obvious, he has constant thoughts about killing women and taking their bodies as part of his own. He reports not being on any medication at the moment. Mental Status Examination: The Mental Status Exam (MSE) will be conducted during the entire interview. This exam will cover a variety of components that will assess the condition of Bundy's mental state at the time of the interview. Ted is well oriented. He is aware of his surroundings and his position in reference to everything around him. His facial expressions are as the normal person's would be. He is somewhat animated and shows no tearful or empathetic expressions. He makes good eye contact and looks as if he wants you to believe everything he is telling you. His gait is steady and relaxed. He seems very comfortable where he is. His attitude towards me is friendly, cooperative, and alluring. He is able to answer my questions with responses that are accurate to the details asked. He wants control over the situation. He shows very inappropriate affect as he is euphoric when explaining how he escaped from jail twice and how one might conduct a murder. Along with his affect being inappropriate, it is also exaggerated. He has a dramatic, theatrical tone to his speech. His words show signs of a histrionic mind set. His thoughts are organized, his memory regarding his life events seem in order and accurate. He does not seem to be making things up. His goal when talking to me is to make sure that I fully understand his story and analyze it as accurately as possible. Lastly, his thought content is unremarkable. The details that he is able to 5 recall is as if he has written it all down and is rehearsing the words back to me. He shows no blame and has no preoccupations with guilt or sadness regarding his crimes. Symptoms and Diagnosis Symptoms: Pathological lying, manipulative behaviors, spontaneous, deceitful, lack of empathy, grandiose thoughts of self, lack of future goals, ignorance of societal norms, anti-social, disregard of others, violent, violates peoples rights, severely depressed at times, lethargic, lack of energy, lack of motivation, narcissistic, lack of inhibition, erratic behavior, lack of remorse, caused the death of 30+ women, necrophilic acts, brutal attacks on women, irresponsibility, heightened excitation During my initial analysis of Ted's symptoms, I believed him to be suffering from Bipolar I disorder. His manic moods that consisted of heightened excitation, grandiose thoughts, and a large amount of energy fulfilled the first stem requirement of a manic episode in the diagnosis of Bipolar I Disorder. These symptoms did not meet the criteria for a Mixed Episode. These symptoms have caused him to use unusual and violent actions against people in society and have caused him to act psychotic, seen in the brutality and completion a number of vicious crimes. On top of the diagnosis of Bipolar I disorder, Ted shows more than the minimal amount of criteria to be identified as having Anti-social Personality Disorder. Since the age of 15, as noted with his disregard for other people's privacy, deceitfulness to forge ski lift tickets, car theft, irresponsibility with his college career, the brutal murders of more than 30 women, impulsivity in his crimes, lack of remorse for these women and their families and other factors, he holds all symptoms of this personality disorder. This diagnosis can be considered a comorbid disorder because the former mentioned actions did not occur only during manic episodes. Also, the actions of his childhood show evidence of Conduct Disorder with a childhood onset. Axis I: 296.54 Bipolar I D/O, Severe with Psychotic Features 312.81 Conduct D/O, Childhood-Onset Type Axis II: 301.7 Antisocial Personality D/O Axis III: None Axis IV: Problems with Primary Support Group: Girlfriend Broke Up Due to Lack of Ambition, Unaware of Biological Father, Abusive Grandfather Problems Related to the Social Environment: Difficulty with Acculturation Educational Problems: Dropped out of College A Couple Times Occupational Problems: Lack of Employment Due to Always Being On The Run Housing Problems: No Settled Household Economic Problems: Inadequate Finances 6 Problems Related to Interaction With The Legal System: Incarcerated and Charged With The Murder Of 30+ Women Axis V: GAF (past): Social: 5 Occupational: 32 Symptoms: 23 (current): Social: 42 Occupational: 41 Symptoms: 55 Case Formulation: The results of this assessment show that Ted Bundy's ability to communicate and live responsively in his surroundings are working at a normal level. His health seems average, but normal for being incarcerated. His memory of the events and his capability of being able to stay focused on the question at hand is above average. This is related to his demeanor, intelligence and deceptive ways. He has shown this behavior with other clinicians and his victims. Ted Bundy's assessment concluded that his actions are common for and meet the requirements for the diagnosis of Bipolar I Disorder, severe with psychotic features, Conduct Disorder with childhood-onset and Anti-Social Personality Disorder. Bundy expressed his former symptoms as being spontaneous, having grandiose thoughts, increase energy and heightened excitation. These symptoms fulfill all of the diagnosis criteria for a Manic Episode. On top of these symptoms, Ted Bundy is also manipulative, disregards the safety and rights of others, has a lack of remorse , has murdered several women, is deceitful and irresponsible, all of which define Anti-Social Personality Disorder. Ted Bundy is not currently taking any medications, but is thriving in his jail environment. His control and relatedness to the situation within the jail allows him to act out in his deceitful ways to the full extent. Ted Bundy's cleanliness, sly demeanor and charming attitude are a sign of his inability to feel remorse or any guilt towards his actions. He took pride in the actions that he give details about and came off with an inappropriate affect in relation to the topics at hand. An approximate order of his symptoms in the past could look like the following: (1) Ted feels as if he cannot be a part of society and begins to isolate himself from every person and every place; (2) He drives around neighborhoods and public areas, possibly while intoxicated, and looks for women or young girls that activate the part of his brain that have been conditioned to bring about violent and immoral acts; (3) He begins to seek that energy in his life and formulates a plan, as well as chooses a specific victim for a specific reason; (4) He commits the acts of violence (rape, murder, disembodiment, etc.) to the woman or women; 7 (5) A sense of euphoria from the completion of the act, the deceitfulness of his actions and the fact that he got away with it pleases him; (6) This heightened state of mind will last a few days to a week, during this time he will be sociable, excited and have grandiose thoughts; (7) After the deterioration of this state of mind, he will fall back into the beginning stage of his depressive state; Let it be noted that the pattern of these mental state of minds is not specifically only during his crimes. Due to the fact that Ted Bundy is a very impulsive and uninhibited man, it is possible that there are biological factors that contributed to his abnormal personality and behavior. His behavior could be explained as being fueled by an over-excitatory behavioral neurotransmitter pathway. Dopamine and serotonin, both associated with pleasure, could be the cause of the feelings he thrived on. Bundy's levels of these neurotransmitters could be low and through his attacks on women, those levels could have raised. Also, there are reward systems (pathways) in which the completion of a goal and/or the lack of punishment from a bad action will condition a person to continue that behavior. Ted's grandfather has been known to express some psychotic or manic features and his grandmother received treatment for depression. A history of mental illness allows the possibility of genetics playing a part in his personality. Facts regarding his father remain unknown, therefore, we can leave space for a possible genetic heredibility of mental disorder coming from his part as well. There are a variety of psychological factors that are also contributing to Ted's mental disorders. Ted experienced a dramatic uncovering of his true parents during the time of his first killings. He found out that the woman he thought was his older sister was, in fact, his mother. His grandparents, who raised him in the beginning, were unstable and his grandfather was very abusive and malice. After his first girlfriend left him due to his in-ambition, his anger and resentment towards her, along with that of his mother, built up and it was soon after that he began, from the information we know, to attack women. Ted seems to be displacing his feelings towards his mother and ex onto women in society (note: the women were apparently similar in appearance to his ex-girlfriend). During his adolescence, he separated himself from others and focused mainly on his school work. This, in turn, caused Ted to be unsure of where he belonged and he began to develop a thought process in which he believed he had to put on an act to get what he wants. This was the beginning of his deceitful and manipulative behavior. Also, Ted always wanted to be able to be sociable and liked. After he would commit these crimes, or when he would be in a manic episode, he would have the utmost confidence and he was the person that he thought he was always meant to be. 8 When Ted was socializing normally in society, he was intertwined with the political scene which he described to be promiscuous and mysterious. With the respect that he received while in these positions, these two elements of the political world could have been bound together. Ted, when thinking of reaching self-identity and power, also thought about how being with women frequently would help him gain power. This, along with the violence that was already conditioned with sexual relations, made his need for control over women unbearable. He would resort to these crimes in order to fulfill that need and get his psychological reward. While growing up, Ted was arrested on accusations of forgery and theft. These cases were expunged from his record when he turned 18. Being able to have what he had done erased was the beginning of his thrill to escape and get away with multiple murders. Due to the biological, psychological and societal factors of Ted Bundy’s life, his thoughts of, his outlook on and his emotionality towards the world became abnormal and extremely dangerous. Cultural Formulation: Ted grew up in a household in which going to church on a regular basis was highly important. He does not recall retaining any lessons or facts that were associated with this church background, but knows that his parents met at a church meeting and liked to go often. He admits that sometimes after he attacked women, he would fall back and feel as if he was going against God. His mother had him at a house for unwed mothers and society, at the time, looked down upon a child been born illegitimately. He has a basic American cultural background. He is only able to speak English, but he has a very eloquent way of speaking to make himself seem of high stature to those around him. It could be said that during Ted's adolescence, he lacked the ability to and did not conform to the typical cultural and societal norms of high school. He would say that he "didn't like to drink" or that he "didn't have time with his studies to go out", but, in reality, he feel incapable of blending with the crowd because he knew he was different. He secretly wanted to be part of life that he so desperately wished for. Currently, Ted views himself as different and higher in quality than that of the average person. He used his knowledge and slyness to make it seem as if he somehow important in the culture. This culture feeds on certain narcissistic personalities and wants to know more about them. Ted has developed a band of followers who admired his dramatic and straight-forward explanations for his behaviors and mindset. Being raised in the same culture, Ted's need for social attention and cultural dominance is similar and familiar to many famous and known people that could be used as an example. Throughout the assessment, Ted continued to remind me that he thinks all of the publicity that he is getting is helping him to solidify who is he as a person. His need for cultural dominance could make it difficult to bring him to reality and inform him of the pathological being he is. Treatment Plan: Antisocial personality disorder is and has been a difficult disorder to treat. For the past few decades, researchers have been trying to find a balance between possible medicine, psychotherapy and cognitive behavioral changes that would be beneficial to those suffering from 9 the disorder. The patients usually believe that they do not need treatment or they know that they do, but they choose to not take part in it specifically because they are being told they have to. When the following possible treatments are being implemented, it is very important to have a close relationship with the patient and follow-up with them on a regular basis. When working with people who have Antisocial Personality Disorder, it is important to make them feel as if they are active and in control of their treatment plan and that they are actively finding solutions to their own problems. Finding a way to help Ted reduce his risk of committing another crime is one of the key problems to address first. A study conducted by Olver, Lewis and Wong (2013) assessed how well risk-reduction treatment worked for high-risk psychopathic offenders. Their participants were 152 males that were federally incarcerated, with eight of them having life sentences. After many controls were contained and analyses of both risk recidivism and therapy change were conducted, they reached the conclusion that the more at-risk the inmate was of committing another crime, the less likely they were to gain positive outcomes after completing a riskreduction treatment. Those results imply that trying to get right at the act of Ted’s committed crimes is not the best psychological path to decreasing his behavior. The effectiveness of general psychotherapeutic treatments for all personality disorders, measured by Bateman (2002) is high, although many psychiatrists have been criticized for lacking the ability to develop a treatment plan that is more effective than not. They investigated what qualities a psychotherapeutic treatment should have to be as effective as possible. They suggested that a plan should be integrated along with other treatments, should be focused on patient compliance and should undoubtably be a long-term program. Supporting this suggestion, a study conducted by Messina and others (2002) found that when comparing those with APD with those without APD, there was no difference in the success of a therapeutic community treatment. Along with this treatment plan, the authors recommend aftercare in the community with support and applications of learned behaviors. This treatment will also depend on Ted’s compliance throughout the entire program. With the knowledge that risk-reduction programs are usually incapable of reducing another future crime and that psychotherapeutic treatment only has some potential to help, Ted would be best treated with a cognitive-behavioral approach that has been shown to be very effective over many years in treating those with psychopathic personalities (Templeman & Wollersheim, 1979). Different than the three treatments mentioned above, this type of approach focuses specifically on how the psychopath sees himself and the world. A program of this kind would not focus on modifying Ted’s behaviors and crimes, but more on how to teach Ted self-control when he has thoughts of behaving in a violent manner. Ted needs to be treated as if he is a normal client and the outcomes of the treatment need to be seen by Ted to be in his favor. When the outcomes are believed to be in his best interest, he will have no choice but to continue treatment or ignore his best interests. A positive outcome, for example, from this type of approach would be the roleplaying suggestions. During this part of the treatment, Ted, with the love of putting on an act to manipulate and deceive those around him, will be asked to play specific pro-social positions in society such as “the good guy”. This will turn Ted away from the negative roles while still allowing him to use his rewarding behaviors to feel in control of the situation. It is not certain 10 that this type of psychotherapy is going to work in Ted’s situation, however, this is my recommendation or an attempted therapy. In reference to any medication that Ted should be put on, the medication should target his Bipolar I disorder, his mood changes and his irrational emotions. The biological reasoning behind using certain medications for this disorder is that there are abnormal neurotransmitter reactions taking place in the brain. Rivas-Vazquez et al. (2002) explained the pathophysiology of the brain and how it points to the limbic system and its involvement with the hypothalamicpituitary axis. This interaction between brain structures entails the neurotransmitters norepinephrine, dopamine and serotonin, all of which are targeted by the medication designed for or that subsequently help with Bipolar disorders. Some of the medications also target GABA and glutamate, two of the inhibitory and excitatory neurotransmitters. The first choice medication for treatment of Bipolar I disorder, and my recommendation of medication is Lithium carbonate. Lithium targets all of the neurotransmitters listed above by increasing GABA, increasing the reuptake of excitatory glutamate, decreasing the breakdown of dopamine, returning norepinephrine to its baseline, and enhancing serotonin and acetylcholine. Lithium would control Ted’s manic behaviors and, in return, hopefully reduce his risk of violent and illegal behaviors. Ted should be referred to a psychiatrist within the jail and his medication should begin immediately, as the full effect of Lithium is seen after 7-14 days, during which the serum levels are achieved. The cognitive-behavioral therapy should also begin right away. Ted will be hesitant to comply, but with the recommendations I have for allowing Ted to control the beginning of the evaluation and assessment will lower his chances of complete ignorance of the program. There is a possibility that none of the recommended treatments for Ted will be successful. He is unlike any patient I have seen and the magnitude of his crimes and behavior might be outside the realm of treatment. 11 References Bateman, A. W. (2000). Effectiveness of psychotherapeutic treatment of personality disorder and tc treatment outcomes. The American Journal of Drug and Alcohol Abuse, 28(2), 197-212. Larsen, R. W. (1980). Bundy: The deliberate stranger. Englewood Cliffs, New Jersey: Prentice Hall. Messina, N. P., Wish, E. D., Hoffman, J. A. & Nemes. (2002). Antisocial personality disorder and and tc treatment outcomes. The American Journal and Drug and Alcohol Abuse, 28(2), 197-212. Michaud, S. & Aynesworth, H. (1989). Ted bundy: Conversations with a serial killer. New York: Signet. Michaud, S. & Aynesworth, H. (1999). The only living witness: The true story of serial sex killer ted bundy. Irving, Texas: Authorlink Press. Olver, M. E., Lewis, K. & Wong, S. P. (2013). Risk reduction treatment of high-risk psychopathic offenders: The relationship of psychopathy and treatment change to violent recidivism. Personality Disorders: Theory, Research, and Treatment, 4(2), 160-167. Rivas-Vazquez, R. A., Johnson, S. L., Rey, G. J., Blais, M. A. & Rivas-Vazquez, A. (2002). Current treatments for bipolar disorder: A review and update for psychologists, Professional Psychology: Research and practice, 33(2), 212-223. Sullivan, K. M. (2009). The bundy murders: A comprehensive history. Jefferson, North Carolina: Mcfarland and Co. Templeman, T. L. & Wollersheim, J. P. (1979). A cognitive-behavioral approach to the treatment 12 of psychopathy. Psychotherapy: Theory, Research & Practice, 16(2), 132-139.
© Copyright 2019