Wow, talk about someone controversial! Dorothy Otnow Lewis holds some views that really make people angry. And what does she believe?

That violent murderers often suffer from mental illness.

Now, most of us would have to agree that people who get off on killing people in particularly gruesome ways have a screw loose. In the book, Dr. Lewis talks about different killers she has examined and the diagnoses she made. She found that many people that she examined suffered from a combination of three conditions:

• Experiencing or witnessing traumatic incidents in childhood.
• Neurological damage from accidents or child abuse, in areas of the brain that help control impulsiveness and judgement.
• Parental discipline so extreme that it qualified as child abuse.

Many of them also suffered from mental illness such as depression, bipolar disorder and, in some cases, dissociative identity disorder. Her position, as she summed it up in 1998, was that suffering from any one of these conditions was not a precursor to violence but that the combination was a “recipe for violence.”

Okay, still nothing there that most of us would disagree with.

The problem is not, I think, that she said it. The problem was where she said it: in courtrooms, during a trials of particularly heinous criminals, people who, really, it would not be safe to let out on the streets, on behalf of the defense.

The problem is that we don’t have a good way to deal with violent killers. In many places, attacking someone with crazy violence is not enough to prove mental illness; so most places either want to put them in jail or execute them. If, on the other hand, you say that they are suffering from neurological damage or mental illness that prevents them from exercising impulse-control, that implies that they could be cured. And once they’re cured, they don’t have to go to jail to serve time for the things they did while they were “ill” – they can just return to society. Describing possible childhood trauma and abuse is also a good way to create sympathy with the jury, something that you absolutely don’t want if you are trying to protect society from them. So testifying that violent killers have neurological damage or mental illness or childhood trauma is a lose-lose.

Despite that, it does seem like Otnow is onto something. The stories she shares about the people she interviewed and studied are compelling. The book starts by discussing Otnow’s training and her work with children. Yes, violent children who stab their best friends. When she asked the children what happened, they did what children do: they shrug; they answer in monosyllables. It’s hard to uncover clues when the best witness won’t cooperate.

Then she goes on to recount stories of people she met who were on death row for particularly violent – and stupid – crimes. And stories of more children who suffered incredible abuse, brain injury, and mental illness, and went on to commit crazily violent crimes. The stories keep coming and, if you don’t have the stomach to read about the terrible things that people do to children, this is not the book for you.

Some of the cases you will recognize, like the story of Marie Moore, who suffered from dissociative identity disorder. I’m pretty skeptical about this order, generally. It’s been used too much in movies and television and people think they can use it to get out of trouble. But, when you read Marie’s story, it rings true.

On the other hand, Shawcross, one of the last stories she tells, seems like he was playing Otnow. There’s just something there, in that interview, that walks like a duck and quacks like a duck, and causes reasonable doubt in me. Unlike many of the criminals Otnow describes, who seem to suffer from, at best, a lack of education, judgement, and memory problems; and, at worst, brain damage that puts them out of touch with reality and causes a distinct lack of comprehension of even basic things about life. Shawcross, however, just seems manipulative. He seems in control. He seems deliberative. Perhaps he had some kind of brain damage. Perhaps he was abused. Perhaps he did suffer from mental illness. And I have no sympathy for him, no belief that he could have been cured, and no desire to see him in any situation that could result in his being released into society again.

The very last story is an interview with someone who has killed many people but has never been charged with a crime: An executioner. Revealing it its own way.

This is a fascinating book, part autobiography, part summary of Otnow’s work, part insight into the justice system. The stories she tells about how she was treated as an expert witness – especially in the Shawcross case where she says the defense lied to her, the prosecution raked her across the coals on the stand, and her phones were tapped; she is lucky only that social media didn’t exist at the time – are appalling.

It’s unfortunate what our justice system has become, how it has ceased to function, and how children in dangerous situations often slip through the cracks.